Low profile plate

ABSTRACT

The present application generally relates to orthopedic systems, and in particular, to systems including independent plates and spacers. A plating system can include a spacer and a plate that is independent from the spacer. A number of locking mechanisms can be provided to secure the plate to the spacer. In some cases, the spacer includes a pair of notches that extend on an outer surface of the spacer. The plate can include a pair of lateral extensions that can engage the notches to secure the plate to the spacer. In other cases, the spacer includes an opening including a pair of inlets. The plate can include an enclosed posterior extension that can be received in the pair of inlets to secure the plate to the spacer.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application of U.S. Ser. No.15/278,481, filed Sep. 28, 2016 (published as U.S. Pat. Pub. No.2017/0071750), which is (i) a continuation-in-part application of U.S.Ser. No. 14/476,439, filed Sep. 3, 2014 (now issued as U.S. Pat. No.9,980,824) and (ii) a continuation-in-part application of U.S. Ser. No.14/727,035, filed Jun. 1, 2015 (now issued as U.S. Pat. No. 9,681,959),which is a continuation-in-part application of U.S. application Ser. No.14/341,035, filed Jul. 25, 2014 (published as U.S. Pat. Pub. No.2014/0336770), which is a continuation-in-part application of U.S. Ser.No. 14/320,200, filed Jun. 30, 2014 (now issued as U.S. Pat. No.9,848,994), which is a continuation-in-part application of U.S. Ser. No.14/190,948, filed Feb. 26, 2014 (now issued as U.S. Pat. No. 9,237,957),which is a continuation-in-part application of (i) U.S. Ser. No.13/785,434, filed Mar. 5, 2013 (now issued as U.S. Pat. No. 9,149,365),and of (ii) U.S. Ser. No. 14/085,318, filed Nov. 20, 2013 (now issued asU.S. Pat. No. 9,398,960), which is a continuation-in-part application ofU.S. patent application Ser. No. 13/785,856, filed Mar. 5, 2013 (nowissued as U.S. Pat. No. 9,204,975), which is a continuation-in-part ofU.S. patent application Ser. No. 13/559,917, filed Jul. 27, 2012 (nowissued as U.S. Pat. No. 8,961,606), which is a continuation-in-part ofSer. No. 13/267,119, filed Oct. 6, 2011 (now issued as U.S. Pat. No.9,770,340), which claims priority to U.S. Provisional Application61/535,726, filed on Sep. 16, 2011 (expired), the entire of contents ofeach of the references are incorporated by reference herein in theirentirety.

FIELD OF THE INVENTION

The present application is generally directed to orthopedic systems, andin particular, to systems including plates and spacers.

BACKGROUND

Spinal discs and/or vertebral bodies of a spine can be displaced ordamaged due to trauma, disease, degenerative defects, or wear over anextended period of time. One result of this displacement or damage maybe chronic back pain. In some cases, to alleviate back pain, the disccan be removed and replaced with an implant, such as a spacer, thatpromotes fusion. In addition to providing one or more spacers, a platingsystem can be used to further stabilize the spine during the fusionprocess. Such a plating system can include one or more plates and screwsfor aligning and holding vertebrae in a fixed position with respect toone another.

Accordingly, there is a need for improved systems involving platingsystems and spacers for spinal fusion and stabilization.

SUMMARY OF THE INVENTION

Various systems, devices and methods related to plating systems areprovided. In some embodiments, a spinal system comprises a spacer forinserting into an intervertebral space and a plate configured to abutthe spacer. The spacer can include an upper surface, a lower surface andan opening that extends between the upper surface to the lower surface,wherein the spacer further includes a tapered leading end. The plate forabutting the spacer can include a plate body, a first opening formed inthe plate body for receiving a first bone screw, a second opening formedin the plate body for receiving a second bone screw, a set screw, and apair of extensions that extend from the plate body that are configuredto engage the spacer. The first opening can be angled in an upwarddirection, while the second opening can be angled in a downwarddirection. The set screw can be configured to prevent back-out of boththe first and the second bone screws, wherein the set screw has a firstposition whereby the first and second bone screws can be inserted pastthe set screw and into the first and second openings and a secondposition following rotation of the set screw whereby the first andsecond bone screws are prevented from backing out by the set screw. Afirst bone screw is provided for inserting into the first opening in theplate body, wherein the first bone screw is configured to be insertedinto a first vertebral body. A second bone screw is provided forinserting into the second opening in the plate body, wherein the secondbone screw is configured to be inserted into a second vertebral bodydifferent from the vertebral body.

In other embodiments, a spinal system comprises a spacer for insertinginto an intervertebral space and a plate configured to abut the spacer.The spacer can include an upper surface, a lower surface and an openingthat extends between the upper surface to the lower surface, wherein thespacer further includes a concave leading end. The plate for abuttingthe spacer can include a plate body, a first opening formed in the platebody for receiving a first bone screw, a second opening formed in theplate body for receiving a second bone screw, a set screw, and a pair ofextensions that extend from the plate body that are configured to engagethe spacer. The first opening can be angled in an upward direction,while the second opening can be angled in a downward direction. The setscrew can be configured to prevent back-out of at least one of the firstand the second bone screws, wherein the set screw has a first positionwhereby at least one of the first and second bone screws can be insertedpast the set screw and into at least one of the first and secondopenings and a second position following rotation of the set screwwhereby at least one of the first and second bone screws are preventedfrom backing out by the set screw. Each of the pair of extensions caninclude a window that extends along a length of the extension. A firstbone screw is provided for inserting into the first opening in the platebody, wherein the first bone screw is configured to be inserted into afirst vertebral body. A second bone screw is provided for inserting intothe second opening in the plate body, wherein the second bone screw isconfigured to be inserted into a second vertebral body different fromthe vertebral body.

In some embodiments, a spinal system comprises a spacer for insertinginto an intervertebral space and a plate configured to abut the spacer.The spacer can include an upper surface, a lower surface and an openingthat extends between the upper surface to the lower surface. The platefor abutting the spacer can include a plate body, a first opening formedin the plate body for receiving a first bone screw, a second openingformed in the plate body for receiving a second bone screw, a set screw,and a pair of extensions that extend from the plate body that areconfigured to engage the spacer. The first opening can be angled in anupward direction, while the second opening can be angled in a downwarddirection. The set screw can be configured to prevent back-out of atleast one of the first and the second bone screws, wherein the set screwhas a first position whereby at least one of the first and second bonescrews can be inserted past the set screw and into at least one of thefirst and second openings and a second position following rotation ofthe set screw whereby at least one of the first and second bone screwsare prevented from backing out by the set screw. Each of the pair ofextensions can include a window that extends along a length of theextension. A first bone screw is provided for inserting into the firstopening in the plate body, wherein the first bone screw is configured tobe inserted into a first vertebral body. A second bone screw is providedfor inserting into the second opening in the plate body, wherein thesecond bone screw is configured to be inserted into a second vertebralbody different from the vertebral body. The spacer and the plate areindependent from one another such that the spacer can be inserted into adesired spinal location prior to abutting the spacer with the plate.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1D illustrate different views of a low profile plate attachedto a spacer according to some embodiments.

FIGS. 2A-2D illustrate different views of the low profile plate shown inFIGS. 1A-1D.

FIGS. 3A-3D illustrate different views of a PEEK spacer to be used withthe low profile plate shown in FIGS. 2A-2D.

FIGS. 4A-4D illustrate different views of an allograft spacer to be usedwith the low profile plate shown in FIGS. 2A-2D.

FIGS. 5A-5D illustrate different views of a second alternativeembodiment of a low profile plate attached to a spacer according to someembodiments.

FIGS. 6A-6D illustrate different views of the low profile plate shown inFIGS. 5A-5D.

FIGS. 7A-7D illustrate different views of a PEEK spacer to be used withthe low profile plate in FIGS. 6A-6D.

FIGS. 8A-8D illustrate different views of an allograft spacer to be usedwith the low profile plate in FIGS. 6A-6D.

FIGS. 9A-9D illustrate different views of a third alternative embodimentof a low profile plate attached to a spacer according to someembodiments.

FIGS. 10A-10D illustrate different views of the low profile plate shownin FIGS. 9A-9D.

FIGS. 11A-11D illustrate different views of a fourth alternativeembodiment of a low profile plate attached to a spacer according to someembodiments.

FIGS. 12A-12D illustrate different views of the low profile plate shownin FIGS. 11A-11D.

FIGS. 13A-13D illustrate different views of a multi-piece allograftspacer to be used with the low profile plates discussed above accordingto some embodiments.

FIGS. 14A-14D illustrate different views of an alternative multi-pieceallograft spacer to be used with the lower profile plates discussedabove according to some embodiments.

FIGS. 15A-15D illustrate different views of an alternative low profileplate attached to a spacer according to some embodiments.

FIGS. 16A-16D illustrate different views of a low profile plate shown inFIGS. 15A-15D.

FIGS. 17A-17C illustrate different views of a spacer shown in FIGS.15A-15D.

FIGS. 18A-18D illustrate different views of another alternative lowprofile plate attached to a spacer according to some embodiments.

FIG. 19 illustrates a lordotic version of the low profile plate andspacer shown in FIGS. 18A-18D.

FIGS. 20A-20D illustrate different views of another alternative lowprofile plate attached to multiple spacers according to someembodiments.

FIGS. 21A and 21B illustrate different views of another alternative lowprofile plate attached to multiple spacers according to someembodiments.

FIG. 22 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments.

FIG. 23 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments.

FIGS. 24A-24C illustrate another alternative low profile plate attachedto a multi-piece spacer having three pieces according to someembodiments.

FIGS. 25A and 25B illustrate another alternative low profile plateattached to a multi-piece spacer having a metal insert according to someembodiments.

FIGS. 26A-26D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments.

FIGS. 27A-27D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments.

FIG. 28 illustrates the plate and spacer in FIGS. 26A-26D in use withina vertebral space.

FIGS. 29A-29C illustrate the plate in FIGS. 26A-26D.

FIGS. 30A-30E illustrate different views of an allograft spacer that canbe used with the plate in FIGS. 26A-26D.

FIGS. 31A-31E illustrate different views of a PEEK spacer that can beused with the plate in FIGS. 26A-26D.

FIGS. 32A and 32B illustrate different views of a spacer having a notchhaving a curved channel in accordance with some embodiments.

FIGS. 33-40 illustrate various views of a vertebral spacer in accordancewith a first exemplary embodiment of the present disclosure.

FIG. 41 is a perspective view of another exemplary intervertebral spacerin accordance with an example of the present disclosure.

FIG. 42 is an insertion device in accordance with an example of thepresent disclosure.

FIGS. 43-46 depict various end or cross-sectional views of the insertiondevice of FIG. 42.

FIGS. 47-49 depict the insertion device of FIG. 42 coupled with anintervertebral anchor in accordance with an example of the presentdisclosure.

FIGS. 50-55 depict an exemplary tool and method of installing avertebral anchor in accordance with an example of the presentdisclosure.

FIG. 56 is a perspective view of another exemplary insertion device inaccordance with an example of the present disclosure.

FIG. 57 is a perspective view of an insertion device and anintervertebral spacer having a plurality of fasteners in accordance withan example of the present disclosure.

FIGS. 58-60 depict another exemplary method of installing a vertebralanchor in accordance with an example of the present disclosure.

FIG. 61 is a side view of a vertebral anchor in accordance with anexample of the present disclosure.

FIG. 62 is an enlarged view of detail A in FIG. 61, illustrating adistal portion of the vertebral anchor of FIG. 29.

FIG. 63 is a top view of the vertebral anchor of FIG. 61.

FIG. 64 is an enlarged view of detail B in FIG. 63, illustrating adistal portion of the vertebral anchor of FIG. 31.

FIG. 65 is a perspective view of the vertebral anchor of FIG. 61.

FIG. 66 is an enlarged view of detail C in FIG. 65, illustrating adistal portion of the vertebral anchor of FIG. 65.

FIG. 67 is another perspective view of the vertebral anchor of FIG. 61.

FIG. 68 is an end view of the vertebral anchor of FIG. 61.

FIGS. 69-72 illustrate various views of another exemplary vertebralanchor in accordance with an example of the present disclosure.

FIG. 73 is a top perspective view of a plate and spacer system withcurved bone anchors in accordance with some embodiments.

FIG. 74 is a top perspective view of a plate and spacer system withstraight bone anchors in accordance with some embodiments.

FIG. 75 is a top perspective view of a plate in accordance with someembodiments.

FIG. 76 is a front view of the plate of FIG. 75.

FIG. 77 is a top view of the plate of FIG. 75.

FIG. 78 is a top perspective view of a PEEK spacer in accordance withsome embodiments.

FIG. 79 is a top perspective view of an allograft spacer in accordancewith some embodiments.

FIG. 80 is a top perspective view of an alternative allograft spacer inaccordance with some embodiments.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

The present application is generally directed to orthopedic systems, andin particular, to systems including plates and spacers.

The present application discloses orthopedic plating systems that can beused in spinal surgeries, such as spinal fusions. The plating systemsdisclosed herein include a plate and a spacer that are independent fromone another. In some cases, the plate and the spacer can be pre-attachedto one another before positioning them in a desired location of thespine. In other cases, the spacer can first be inserted into a desiredlocation of the spine, and then the plate can be inserted thereafter.Advantageously, the plating systems disclosed herein are of low-profile.For example, they can provide a very small, anterior footprint cervicalplate solution for fusion procedures. One skilled in the art willappreciate that while the plating systems can be used with cervicalprocedures, the plating systems are not limited to such areas, and canbe used with other regions of the spine.

FIGS. 1A-1D illustrate different views of a plating system comprising alow profile plate attached to a spacer according to some embodiments.The plating system 5 includes a spacer 10 attached to a low-profileplate 50. Advantageously, the plating system 5 can be inserted throughan anterior approach into a spine, and can desirably provide a smallanterior footprint.

The spacer 10 is configured to have an upper surface 12, a lower surface14, and a leading end 22. In some embodiments, the upper surface 12and/or lower surface 14 includes texturing 16, such as teeth, ribs,ripples, etc. to assist in providing frictional contact with adjacentvertebral bodies. In some embodiments, the leading end 22 of the spacer10 can be slightly tapered, as shown in FIG. 1A. With the taper, theleading end 22 can serve as a distraction surface that helps the spacerto be inserted into an intervertebral space. As shown in FIG. 1B, theleading end 22 can be concave, though in other embodiments, the leadingend 22 can be straight or convex.

The spacer 10 can be substantially C-shaped (as shown in FIG. 3B),whereby it includes two side arms 13 that surround an inner opening 20.Adjacent the side arms 13 is a convex wall 19. In some embodiments, theconvex wall 19 is substantially parallel to the concave surface of theleading end 22. The opening 20, which is configured to receive naturalor synthetic graft material therein to assist in a fusion procedure, hasan open side that is opposite convex wall 19, thereby giving the spacer10 its C-shape.

The spacer 10 has a number of unique features that accommodate theattachment of a plate 50 thereto. Each of the side arms 13 of the spacer10 includes a notch 17 (shown in FIG. 3B) for receiving a correspondingprotrusion 71 of a lateral arm or extension 70 of the plate 50, therebyadvantageously forming a first locking mechanism between the spacer 10and the plate 50. In addition, in some embodiments, each of the sidearms 13 of the spacer 10 can also include a hump region 26 (shown inFIG. 3B) that can extend in part into a window 72 of an attached plate50 (shown in FIG. 2A), thereby advantageously providing a second lockingmechanism between the spacer 10 and the plate 50. Advantageously, byproviding secure first and second locking mechanisms between the spacer10 and the plate 50, the plate and spacer will be kept securely togetherduring any type of impaction of the plating system within the body.Furthermore, each of the side arms 13 of the spacer 10 can include acut-away portion or chamfer 18, 19 (shown in FIG. 3C) to advantageouslyaccommodate screws which pass through the plate. In embodiments thatinvolve a pair of screws through the plate 50—one of which passes in anupward direction, and the other of which passes in a downwarddirection—one side arm 13 of the spacer 10 will include an upper chamfer18 formed on an upper surface to accommodate the upwardly directedscrew, while the second side arm 13 of the spacer will include a lowerchamfer 19 formed on a lower surface to accommodate the downwardlydirected screw.

The spacer 10 can be formed of any material. In some embodiments, thespacer 10 is formed of a polymer, such as PEEK, as shown in FIG. 3A. Insome embodiments, the spacer 10 is formed of allograft bone, as shown inFIG. 4A. In some instances, to form an allograft implant, allograft bonemay be cut or shaved from a desired bone member. The cut allograft bonewill then be assembled together, using an adhesive or mechanicalfastener (e.g., bone pins). Accordingly, in some embodiments, anallograft spacer 10 is formed of two, three, four or more layers thatare assembled together, such as by one or more bone pins. One particularadvantage of the invention is that the plate 50 can work with a varietyof different spacers 10, as the plate 50 is independently removable fromand attachable to the spacer 10. Regardless of whether a surgeon choosesto implant an allograft spacer or PEEK spacer 10 into an intervertebralspace, the surgeon can simply attach the low-profile plate 50 to thespacer 10 following implantation into the intervertebral space.

The plate 50 is configured to have a plate body and a pair of lateralextensions 70 that extend from the plate body, each of which has aprotrusion 71, for inserting into a corresponding notch 17 of the spacer10. These lateral extensions 70 help form the first locking mechanismbetween the plate 50 and the spacer 10, as discussed above. In addition,the lateral extensions 70 of the plate 50 each include a window 72(shown in FIG. 2A) for receiving a hump region 26 on the arms 17 of thespacer 10, thereby helping to form the second locking mechanism betweenthe plate 50 and the spacer 10, as discussed above.

In addition to attaching to the spacer 10, the plate 50 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws. As shown in FIG. 1A, the plate 50 includes a first screwhole 52 and a second screw hole 54 for receiving bone screws therein. Insome embodiments, screw hole 52 is angled upwardly such that an insertedbone screw passes upward into an upper vertebral body, while screw hole54 is angled downwardly such that an inserted bone screw passes downwardinto a lower vertebral body. While the illustrated embodimentillustrates a pair of screw holes for receiving a pair of bone screws,it is possible to have one, three, four, five or more screw holes forreceiving a different number of bone screws.

Over time, it is possible for bone screws to back-out. The plate 50 thushas a blocking or set screw 56 (shown in FIG. 1C) that assists inpreventing back-out of inserted bone screws. As shown in FIG. 1C, theset screw 56 can be in an initial position that allows first and secondbone screws to pass through holes 52, 54. Once the bone screws have beeninserted through the holes 52, 54, the set screw 56 can be rotated(e.g., 90 degrees), to thereby block the bone screws and prevent backout of the bone screws. In some embodiments, the set screw 56 abuts aside of the head of the bone screws to prevent back-out of the bonescrews, while in other embodiments, the set screw 56 rests over a top ofthe head of the bone screws to prevent back-out of the bone screws. Insome embodiments, the set screw 56 comes pre-fixed with the plate 50. Asshown in FIG. 1C, a single set screw 56 can be used to convenientlyblock a pair of bone screws. In other embodiments, each bone screw canbe assigned its own set screw, which can operate independently of oneanother, to prevent back-out of the bone screw.

The plate 50 can also include one or more knife-like edges 63 thatprovide additional torsional stabilization when the plate 50 restsagainst a bone member. As shown in FIG. 1C, the knife-like edges 63 canbe formed on both the upper and lower surfaces of the plate 50 body.While the illustrated embodiment shows a pair of knife-like edges 63 onan upper surface of the plate body and a pair of knife-like edges 63 ona lower surface of the plate body, one skilled in the art willappreciate that a different number of knife-like edges 63 can beprovided.

FIGS. 2A-2D illustrate different views of the low profile plate shown inFIGS. 1A-1D. From these views, one can see the pair of lateralextensions 70 that extend from the body of the plate 50. At the distalend of each of the lateral extensions 70 is an inwardly-facingprotrusion 71 that is configured to fit into a corresponding notch inthe spacer 10. In addition, from these views, one can see the windows 72that are formed in each of the lateral extensions 70. The windows 72advantageously receive hump regions 26 of the spacer to provide alocking mechanism, and also help to improve desirable radiolucency.Advantageously, the windows 72 can have rounded edges to accommodate thespacer 10 therein. While the illustrated windows 72 are shown asrectangular with rounded edges, in other embodiments, the windows 72 canhave a different shape, such as circular or oval. In some embodiments,the plate 50 is assembled axially to the spacer 10.

In some embodiments, the low profile plate 50 can also include indentedgripping sections 73 (shown in FIGS. 2A and 2B). These indented grippingsections 73 advantageously provide a gripping surface for an insertioninstrument, thereby facilitating easy delivery of the plate to a spacerbody during surgery.

FIGS. 3A-3D illustrate different views of a PEEK spacer to be used withthe low profile plate shown in FIGS. 2A-2D. From these views, one cansee how the spacer 10 a includes an upper surface 12 a and a lowersurface 14 a with texturing 16 a; a generally C-shaped body including apair of arms 13 a each having a notch 17 a formed therein and an upperchamfer 18 a or lower chamfer 19 a; and a tapered leading edge 22 a. Inaddition, one skilled in the art can appreciate the substantiallysymmetric shape of the inner opening 20 a, which serves as a graft holefor receiving graft material therein.

FIGS. 4A-4D illustrate different views of an allograft spacer to be usedwith the lower profile plate shown in FIGS. 2A-2D. While the allograftspacer 10 b shares similar features to the PEEK spacer 10 a shown inprevious figures, such as the notches 17 b, hump surfaces 26 b, andchamfers 18 b,19 b, the allograft spacer 10 b need not be the same. Forexample, the shape of the graft opening 20 b can be more of an arch, asshown in FIG. 4B.

FIGS. 5A-5D illustrate different views of a second alternativeembodiment of a low profile plate attached to a spacer according to someembodiments. Rather than having a plate 50 with lateral extensions 70that extend around the outer surface of a spacer 10, the presentembodiment of the plating system 105 includes a plate 150 with anenclosed posterior extension 155 that fits within the body of the spacer110. The enclosed posterior extension 155 includes extending surfaces166, 167 that are fitted into corresponding inlets 121, 123 formed inthe body of the spacer 120, thereby forming a first locking mechanismbetween the plate 150 and the spacer 110. In addition, the enclosedposterior extension 155 of the plate 50 includes one or more deformablelocking tabs 160 (shown in FIG. 6B) that securely lock into tab holes181 a in the spacer body 110, thereby forming a second locking mechanismbetween the plate 150 and the spacer 110. While in some embodiments, theplate 150 can be attached to the spacer 110 after inserting the spacer110 into a desired location in the body, in other embodiments, the plate150 can be pre-assembled with the spacer 110 prior to inserting theplating system 105 into the desired location.

Like the spacer 10 in FIG. 1A, the spacer 110 is configured to have anupper surface 112, a lower surface 114, and a leading end 122. In someembodiments, the upper surface 112 and/or lower surface 114 includestexturing 116, such as teeth, ribs, ripples, etc. to assist in providingfrictional contact with adjacent vertebral bodies. In some embodiments,the leading end 122 of the spacer 110 can be slightly tapered, as shownin FIG. 7D. With the taper, the leading end 122 can serve as adistraction surface that helps the spacer 110 to be inserted into anintervertebral space. As shown in FIG. 1B, the leading end 122 can beconcave, though in other embodiments, the leading end 122 can bestraight or convex.

The spacer 110 can be substantially C-shaped (as shown in FIG. 7B),whereby it includes two side arms 113 that surround an inner opening120. Adjacent the side arms 113 is a straight wall 119 that forms theborder of the graft opening 120. The straight wall 119 can include oneor more tab holes 181 (shown in FIG. 7A) for receiving deformable tablocks 160 therein. The graft opening 20, which is configured to receivenatural or synthetic graft material therein to assist in a fusionprocedure, has an open side that is opposite the straight wall 119,thereby giving the spacer 110 its C-shape.

In some embodiments, the graft opening 120 (shown in FIG. 7B) has adifferent shape from the opening 20 of the spacer 10 of the priorembodiment, as the graft opening 120 is configured to not only receivegraft material, but also the enclosed posterior extension 155 of theplate 150. For example, the graft opening 120 includes two inlets—afirst inlet 121 formed at the junction between the first arm 113 andwall 119 and a second inlet 123 formed at the junction between thesecond arm 113 and wall 119 (shown in FIG. 7B)—for receiving outwardlyextending surfaces 166, 167 of the plate 150 (shown in FIG. 6B). Inaddition, the graft opening 120 includes two outwardly tapering walls111 that provide enough space to accommodate any bone screws inserted inthe plate 150. As such, additional chamfers 18, 19 (as shown in FIG. 3B)are optional.

Like spacer 10, the spacer 110 can be formed of a variety of materials.In some embodiments, the spacer 110 comprises PEEK, as shown in FIG. 7A,while in other embodiments, the spacer 110 comprises allograft bone, asshown in FIG. 8A.

The plate 150 is configured to have a plate body, and an enclosedposterior extension 155 that extends from the plate body, which isreceived within and retains the spacer 110. The enclosed posteriorextension 155 includes first and second outwardly extending surfaces166, 167 that fit into inlets 121, 123 formed within the spacer 110 bodyto form a first locking mechanism. In addition, one or more deformabletab locks 160 extend from an exterior surface of the enclosed posteriorextension 155 and are received in corresponding tab holes 181 in thespacer 150 to form a second locking mechanism. In some embodiments, theside walls of the enclosed posterior extension 155 can include one ormore windows 172 (shown in FIG. 6A) for improving radiolucency of theplating system. In some embodiments, the plate 150 is assembled axiallyto the spacer 110.

In addition to attaching to the spacer 110, the plate 150 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws 88, 89. As shown in FIG. 5A, the plate 150 includes a firstscrew hole 152 and a second screw hole 154 for receiving bone screws 88,89 therein. In some embodiments, screw hole 152 is angled upwardly suchthat an inserted bone screw 88 passes upward into an upper vertebralbody, while screw hole 154 is angled downwardly such that an insertedbone screw 89 passes downward into a lower vertebral body. While theillustrated embodiment illustrates a pair of screw holes for receiving apair of bone screws, it is possible to have one, three, four, five ormore screw holes for receiving a different number of bone screws.

Over time, it is possible for bone screws to back-out. The plate 150thus has a blocking or set screw 156 (shown in FIG. 5C) that assists inpreventing back-out of inserted bone screws. As shown in FIG. 5C, theset screw 156 can be in an initial position that allows first and secondbone screws to pass through holes 152, 154. Once the bone screws havebeen inserted through the holes 152, 154, the set screw 156 can berotated (e.g., 90 degrees), to thereby block the bone screws and preventback out of the bone screws. In some embodiments, the set screw 156abuts a side of the head of the bone screws to prevent back-out of thebone screws, while in other embodiments, the set screw 156 rests over atop of the head of the bone screws to prevent back-out of the bonescrews. In some embodiments, the set screw 156 comes pre-fixed with theplate 150. As shown in FIG. 5C, a single set screw 156 can be used toconveniently block a pair of bone screws. In other embodiments, eachbone screw can be assigned its own set screw, which can operateindependently of one another, to prevent back-out of the bone screw.

The plate 150 can also include one or more torsional stabilizers 163. Insome embodiments, the torsional stabilizers 163 can comprise knife-likeedges 163 that provide additional torsional stabilization when the plate150 rests against a bone member. As shown in FIG. 5C, the knife-likeedges 163 can be formed on both the upper and lower surfaces of theplate 150 body. While the illustrated embodiment shows a pair ofknife-like edges 163 on an upper surface of the plate body and a pair ofknife-like edges 163 on a lower surface of the plate body, one skilledin the art will appreciate that a different number of knife-like edges163 can be provided. In some embodiments, the torsional stabilizers 163are flush with the body of the plate 150.

FIGS. 6A-6D illustrate different views of the low profile plate shown inFIGS. 5A-5D. From these views, one can see the enclosed posteriorextension 155 that extends from the body of the plate 150. At the distalend of the enclosed posterior extension 155 are a pair of outwardlyextending surfaces 166, 167 that are configured to fit within inlets121, 123 formed in the spacer. From these views, one can also see thedeformable tab lock 160 (FIG. 6B) that can help secure the plate 150 tothe spacer 110. In addition, from these views, one can see the windows172 that are formed in each of the arms of the enclosed posteriorextension 155. The windows 172 advantageously help to improve desirableradiolucency, and are of large size to provide a large viewing surfacearea. While the illustrated windows 172 are shown as triangular withrounded edges, in other embodiments, the windows 172 can have adifferent shape, such as circular or oval. In some embodiments, theplate 150 is assembled axially to the spacer 110.

In some embodiments, the low profile plate 150 can also include indentedgripping sections 173 (shown in FIGS. 6A and 6B). These indentedgripping sections 173 advantageously provide a gripping surface for aninsertion instrument, thereby facilitating easy delivery of the plate toa spacer body during surgery.

FIGS. 7A-7D illustrate different views of a PEEK spacer to be used withthe low profile plate shown in FIGS. 5A-5D. From these views, one cansee how the spacer 110 a includes an upper surface 112 a and a lowersurface 114 a with texturing 116 a; a generally C-shaped body includinga pair of arms 113 a each having an inner inlet 121, 123 a formedtherein; and a tapered leading edge 122 a. In addition, one skilled inthe art can appreciate the substantially symmetric shape of the inneropening 120 a, which serves as a graft hole for receiving graft materialtherein.

FIGS. 8A-8D illustrate different views of an allograft spacer to be usedwith the lower profile plate shown in FIGS. 5A-5D. While the allograftspacer 110 b shares similar features to the PEEK spacer 110 a shown inprevious figures, such as the C-shaped body including a pair of arms 113b each having an inlet 121 b, 123 b formed therein, the allograft spacer110 b need not be the same.

FIGS. 9A-9D illustrate different views of a third alternative embodimentof a low profile plate attached to a spacer according to someembodiments. In the present embodiment, the plating system 205 includesa plate 250 having lateral arms or extensions 270 that extend around anexterior surface of a spacer 210. The lateral extensions 270 extendwider than the lateral extensions 70 in the first embodiment, and do notnecessarily have to interlock with the spacer 210. While in someembodiments, the plate 250 can be attached to the spacer 210 afterinserting the spacer 210 into a desired location in the body, in otherembodiments, the plate 250 can be pre-assembled with the spacer 210prior to inserting the plating system 205 into the desired location.

Like the spacer 10 in FIG. 1A, the spacer 210 is configured to have anupper surface 212, a lower surface 214, and a leading end 222. In someembodiments, the upper surface 212 and/or lower surface 214 includestexturing 216, such as teeth, ribs, ripples, etc. to assist in providingfrictional contact with adjacent vertebral bodies. In some embodiments,the leading end 222 of the spacer 210 can be slightly tapered, as shownin FIG. 9D. With the taper, the leading end 222 can serve as adistraction surface that helps the spacer 210 to be inserted into anintervertebral space. As shown in FIG. 9B, the leading end 222 can beslightly concave, though in other embodiments, the leading end 122 canbe straight or convex. Unlike previously illustrated spacers, the spacer210 can have a graft hole 220 that is completely enclosed. As shown inFIG. 9B, the graft hole 220 can surrounded by four walls. In addition,the spacer 210 can include four outer walls: two straight walls, aconvex wall and a concave wall.

In some embodiments, the graft opening 220 (shown in FIG. 9B) has adifferent shape from the openings of prior embodiments, as the graftopening 220 is enclosed. While the graft opening 220 is rectangular withrounded edges, in other embodiments, the graft opening 220 can have adifferent shape. For example, in some embodiments, the graft opening 220can have curved walls, instead of straight walls, or can have taperedwalls, instead of straight walls.

Like spacer 10, the spacer 210 can be formed of a variety of materials.In some embodiments, the spacer 210 comprises allograft bone, while inother embodiments, the spacer 210 comprises PEEK.

The plate 250 is configured to have a pair of lateral extensions 270that receive the spacer 220. As shown in FIG. 9A, in some embodiments,the lateral extensions 270 include one or more windows 272 for improvingradiolucency of the plating system. In some embodiments, the plate 250is assembled axially to the spacer 210.

In addition to capturing the spacer 210, the plate 250 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws 88, 89. As shown in FIG. 9A, the plate 250 includes a firstscrew hole 252 and a second screw hole 254 for receiving bone screws 88,89 therein. In some embodiments, screw hole 252 is angled upwardly suchthat an inserted bone screw 88 passes upward into an upper vertebralbody, while screw hole 254 is angled downwardly such that an insertedbone screw 89 passes downward into a lower vertebral body. While theillustrated embodiment illustrates a pair of screw holes for receiving apair of bone screws, it is possible to have one, three, four, five ormore screw holes for receiving a different number of bone screws.

Over time, it is possible for bone screws to back-out. The plate 250thus has a blocking or set screw 256 (shown in FIG. 9C) that assists inpreventing back-out of inserted bone screws. As shown in FIG. 9C, theset screw 256 can be in an initial position that allows first and secondbone screws to pass through holes 252, 254. Once the bone screws havebeen inserted through the holes 252, 254, the set screw 256 can berotated (e.g., 90 degrees), to thereby block the bone screws and preventback out of the bone screws. In some embodiments, the set screw 256abuts a side of the head of the bone screws to prevent back-out of thebone screws, while in other embodiments, the set screw 256 rests over atop of the head of the bone screws to prevent back-out of the bonescrews. In some embodiments, the set screw 256 comes pre-fixed with theplate 250. As shown in FIG. 9C, a single set screw 256 can be used toconveniently block a pair of bone screws. In other embodiments, eachbone screw can be assigned its own set screw, which can operateindependently of one another, to prevent back-out of the bone screw.

FIGS. 10A-10D illustrate different views of the low profile plate shownin FIGS. 9A-9D. From these views, one can see the lateral extensions 270that extend from the body of the plate 250. From these views, one canalso see the windows 272 (FIG. 10A) that extend along a substantiallength of the lateral extensions 270. In some embodiments, each window272 has a length greater than half the length of each lateral extension270, thereby advantageously increasing the radiolucency of the platingsystem. In some embodiments, the plate 250 is assembled axially to thespacer 210.

In some embodiments, the low profile plate 250 can also include indentedgripping sections 273 (shown in FIGS. 10A and 10B). These indentedgripping sections 273 advantageously provide a gripping surface for aninsertion instrument, thereby facilitating easy delivery of the plate toa spacer body during surgery.

FIGS. 11A-11D illustrate different views of a fourth alternativeembodiment of a low profile plate attached to a spacer according to someembodiments. Like the previous embodiment, the plating system 305includes a plate 350 having lateral arms or extensions 370 that extendaround an exterior surface of a spacer 310. The lateral extensions 370extend wider than the lateral extensions 70 in the first embodiment, anddo not necessarily have to interlock with the spacer 310. While in someembodiments, the plate 350 can be attached to the spacer 310 afterinserting the spacer 310 into a desired location in the body, in otherembodiments, the plate 350 can be pre-assembled with the spacer 310prior to inserting the plating system 305 into the desired location.

Like the spacer 10 in FIG. 1A, the spacer 310 is configured to have anupper surface 312, a lower surface 314, and a leading end 322. In someembodiments, the upper surface 312 and/or lower surface 314 includestexturing 316, such as teeth, ribs, ripples, etc. to assist in providingfrictional contact with adjacent vertebral bodies. In some embodiments,the leading end 322 of the spacer 310 can be slightly tapered, as shownin FIG. 11D. With the taper, the leading end 322 can serve as adistraction surface that helps the spacer 310 to be inserted into anintervertebral space. As shown in FIG. 11B, the leading end 322 can beslightly concave, though in other embodiments, the leading end 322 canbe straight or convex. In some embodiments, the spacer 310 can have agraft hole 320 that is completely enclosed. As shown in FIG. 11B, thegraft hole 320 can surrounded by four walls. In addition, the spacer 320can be comprised of four outer walls: two straight, one concave and oneconvex.

In some embodiments, the graft opening 320 (shown in FIG. 11B) of thespacer 310 is enclosed. While the graft opening 320 is rectangular withrounded edges, in other embodiments, the graft opening 320 can have adifferent shape. For example, in some embodiments, the graft opening 320can have curved walls, instead of straight walls, or can have taperedwalls, instead of straight walls.

Like spacer 10, the spacer 310 can be formed of a variety of materials.In some embodiments, the spacer 210 comprises allograft bone, while inother embodiments, the spacer 310 comprises PEEK.

The plate 350 is configured to have a pair of lateral extensions 370that receive the spacer 320. As shown in FIG. 11A, in some embodiments,the lateral extensions 370 include one or more windows 372 for improvingradiolucency of the plating system. In some embodiments, the plate 350is assembled axially to the spacer 310.

In addition to capturing the spacer 310, the plate 350 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws 88, 89. As shown in FIG. 9A, the plate 350 includes a firstscrew hole 351, a second screw hole 352 and a third screw hole 354 forreceiving bone screws 87, 88, 89 therein. In some embodiments, screwholes 352 and 354 are angled upwardly such that inserted bone screws 87,88 pass upward into an upper vertebral body, while screw hole 351 isangled downwardly such that inserted bone screw 89 passes downward intoa lower vertebral body. While the illustrated embodiment illustratesthree screw holes for receiving three bone screws, it is possible tohave one, two, four, five or more screw holes for receiving a differentnumber of bone screws.

Over time, it is possible for bone screws to back-out. The plate 350thus has blocking or set screws 356, 357, 358 (shown in FIG. 12C), eachof which corresponds to one of screw holes 351, 352, 354. As shown inFIG. 12C, the set screws 356, 357, 358 can be in an initial positionthat allows first, second and third bone screws to pass through holes351, 352, 354. Once the bone screws have been inserted through the holes351, 352, 354, the set screws 356, 357, 358 can be rotated (e.g., 90degrees), to thereby block the bone screws and prevent back out of thebone screws. In some embodiments, the set screws 356, 357, 358 abut aside of the head of the bone screws to prevent back-out of the bonescrews, while in other embodiments, the set screws 356, 357, 358 restover a top of the head of the bone screws to prevent back-out of thebone screws. In some embodiments, the set screws 356, 357, 358 comepre-fixed with the plate 350. As shown in FIG. 12C, a single set screw356, 357, 358 can be used to conveniently block a single bone screws. Inother embodiments, each set screw can be designed to block more than oneset screw to prevent back-out of the bone screw.

FIGS. 12A-12D illustrate different views of the low profile plate shownin FIGS. 11A-11D. From these views, one can see the lateral extensions370 that extend from the body of the plate 350. From these views, onecan also see the windows 372 (FIG. 12A) that extend along a substantiallength of the lateral extensions 370. In some embodiments, each window372 has a length greater than half the length of each lateral extension370, thereby advantageously increasing the radiolucency of the platingsystem. In some embodiments, the plate 350 is assembled axially to thespacer 310.

The plating systems describe include a plate that is independent from aspacer. The plate is low-profile and can be used with any type ofspacer, such as allograft or PEEK.

FIGS. 13A-13D illustrate different views of a multi-piece allograftspacer to be used with the low profile plates discussed above accordingto some embodiments. The multi-piece allograft spacer 410 can be formedof an upper member 436 and a lower member 438 that are connectedtogether via one or more pins 475. The upper member 436 and the lowermember 438 each include cut-out portions that help form a graft opening420 in the spacer 410.

The upper member 436 can include an upper surface having bone engagementsurfaces (e.g., ridges, teeth, ribs) and a lower interfacing surface446. The lower member 438 can include a lower surface having boneengagement surfaces (e.g., ridges, teeth, ribs) and an upper interfacingsurface 448. In some embodiments, the upper member 436 can include oneor more holes 462, while the lower member 438 can include one or moreholes 464 which align with the one or more holes 462 of the uppermember. The aligned holes are configured to receive one or more pins 475to keep the upper and lower members of the allograft spacer together. Insome embodiments, the pins 475 are also formed of bone material, such asallograft.

As shown best in FIG. 13C, the lower interfacing surface 446 of theupper member 436 is directly engaged with the upper interfacing surface448 of the lower member 438. While the lower interfacing surface 446 andthe upper interfacing surface 448 can be flat-on-flat, as both surfacesare planar, in some embodiments (as shown in FIG. 13C), the interfacebetween the two surfaces is at an angle relative to the holes forreceiving the pins 475. In other words, the pins 475 are received at anangle to the interface between the upper member 436 and the lower member438. In addition, as shown in FIG. 13C, holes 462 and 464 need not gothrough the entirety of their respective members. For example, as shownin FIG. 13C, while hole 462 goes entirely through the upper and lowersurface of the upper member 436, hole 464 goes only through the uppersurface of the lower member 438, and does not go through to the lowersurface. Accordingly, in some embodiments, aligned holes 462 and 464create a “blind” pin-hole, whereby the hole does not go through theuppermost and lowermost surfaces of the spacer 410. Advantageously, insome embodiments, the use of such blind holes for receiving pins helpsto maintain the pins within the spacer body.

FIGS. 14A-14D illustrate different views of an alternative multi-pieceallograft spacer to be used with the lower profile plates discussedabove according to some embodiments. The multi-piece allograft spacer510 can be formed of a left member 536 and a right member 538 that areconnected together in series or side-by-side (e.g., laterally) via oneor more pins 575. The left member 536 and the right member 538 eachinclude cut-out portions that help form a graft opening 520 in thespacer 510.

The left member 536 can include upper and lower surfaces having boneengagement surfaces (e.g., ridges, teeth, ribs). In addition, the leftmember 536 further includes a right interfacing surface 546. The rightmember 538 can also include upper and lower surfaces having boneengagement surfaces (e.g., ridges, teeth, ribs). In addition, the rightmember 538 further includes a left interfacing surface 548. In someembodiments, the left member 536 can include one or more holes 562,while the right member 538 can include one or more holes 564 which alignwith the one or more holes 562 of the left member. The aligned holes areconfigured to receive one or more pins 575 to keep the left and rightmembers of the allograft spacer together.

As shown best in FIG. 14A, the right interfacing surface 546 of the leftmember 536 is directly engaged with the left interfacing surface 548 ofthe right member 538. While the right interfacing surface 546 and theleft interfacing surface 548 can be flat-on-flat, as both surfaces areplanar, in some embodiments (as shown in FIG. 14A), the interfacebetween the two surfaces is at an angle relative to the holes forreceiving the pins 575. In other words, the pins 575 are received at anangle to the interface between the left member 536 and the right member538. In addition, as shown in FIG. 14B, holes 562 and 564 need not gothrough the entirety of their respective members. In other words, one ormore of the holes (e.g., holes 562, 564 or combined) can be blind holes,whereby the holes do not go through the left and right surfaces of thelateral implants.

By having multi-piece allograft spacers that are either stacked oraligned side-by-side, it is possible to have spacers of increased heightand width. While the embodiments herein show two piece spacers, oneskilled in the art will appreciate that three or more members can becombined to form multi-piece allograft spacers for use with any of theplate members described above.

FIGS. 15A-15D illustrate different views of an alternative low profileplate attached to a spacer according to some embodiments. The platingsystem 605 comprises a plate 650 attached or mounted to a spacer 610.

The system 605 includes a number of similar features to priorembodiments. The spacer 610 includes a body having an upper surface 612and a lower surface 614 with texturing (e.g., ribs, grooves, teeth,protrusions) and sidewalls including one or more notches 617 forreceiving plate extensions. The body of the spacer 610 can be U-shapedor C-shaped, such that a central portion includes a graft opening 620for receiving graft material therein. The plate 650 includes a bodyhaving a first screw hole 652 for receiving a first screw membertherethrough, a second screw hole 654 for receiving a second screwmember therethrough, and a recess for receiving a blocking fastener orset screw 656. In addition, a pair of extension arms or members 670extend from the plate body and are received in each of the notches 617formed in the spacer 10. Each of the extension members 617 includes awindow 672 for receiving a hump portion or region of the spacer tofurther secure the spacer 610 with the plate 650. In addition, the platemember 650 can include one or more stabilizers or knife-like edges 663that can help secure the plate member 650 to a vertebral body. While thestabilizers 663 are shown as sharp and pointed, in other embodiments,the stabilizers 663 are more blunt and in some cases, even slightlyrounded.

The plating system 605 in FIGS. 15A and 15D is unique in that the firstupper screw hole 652 has been raised such that a central axis of thefirst upper screw hole 652 is positioned higher than the upper surface612 of the spacer 610. In addition, the second lower screw hole 654 hasbeen lowered such that a central axis of the second lower screw hole 654is positioned below the lower surface 614 of the spacer 610. As shown inFIG. 15B, each of the holes 652, 654 has an adjacent brow member thatextends from the plate body. First screw hole 652 is adjacent upper browmember 662, while second screw hole 654 is adjacent lower brow member664. Upper brow member 662 has been raised to accommodate the raisedupper screw hole 652, while lower brow member 664 has been lowered toaccommodate the lowered lower screw hole 654.

Advantageously, by raising the upper screw hole 652 and lowering thelower screw hole 654, this reduces the likelihood of any viewingobstruction that may occur from the spacer 610. Moreover, even thoughthe upper brow member 662 is raised and the lower brow member 664 islowered, advantageously, the plating system 605 still maintains a lowprofile such that most if not all of the plate system remains in a discspace. In other embodiments, it may be desired for a part of the upperbrow member 662, a part of the lower brow member 664 or both to contacta vertebral face (e.g., an anterior face), thereby providing stabilityto the plating system 605.

FIGS. 16A-16D illustrate different views of a plate member 650 used inthe plating system 605. From these views, one can clearly see how theupper brow member 662 and first upper hole member 652 have been raised,while the lower brow member 664 and second lower hole member 664 havebeen lowered, relative to other designs. In some embodiments, the entirecentral axis of first upper hole member 652 (e.g., from a front of theplate member 650 to a back of the plate member 650) is continuouslyabove the upper surface of the spacer, thereby advantageously providinga less unobstructed view of the first upper hole member 652. Likewise,in some embodiments, the entire central axis of the second lower holemember 654 (e.g., from a front of the plate member 650 to a back of theplate member 650) is continuously below the lower surface of the spacer,thereby advantageously providing a less unobstructed view of the secondlower hole member 654.

FIGS. 17A-17C illustrate different views of a spacer 610 used in theplating system 605. From these views, one can clearly see features ofthe spacer 610 includes its upper surface 612, lower surface 614,sidewalls with notches 617 and graft opening 620. In addition, with theplate member removed from the views, one can also see an upper chamfer618 a and a lower chamfer 618 b that are cut into the spacer 610. Thesechamfers 618 a, 618 b advantageously provide clearance for bone screwsthat are inserted through the plating system 605. One skilled in the artwill appreciate that the spacer can be made of many different materials.In some embodiments, the spacer will be made out of bone (e.g.,allograft), while in other embodiments, the spacer will be made of PEEK.Advantageously, the plating system 605 is removably attached to thespacer 610 such that a surgeon can choose to include a spacer of acertain material as so desired during a surgical procedure.

FIGS. 18A-18D illustrate different views of yet another plate systeminvolving a plate member and a spacer having a unique multi-piececomposition in accordance with some embodiments. The plate system 705includes similar elements as found in prior embodiments, including aplate member 750 having a first upwardly oriented screw hole 752 forreceiving a first screw, a second downwardly oriented screw hole 754 forreceiving a second screw, and a blocking member or screw 756, as well asa spacer 710 (e.g., allograft or PEEK) having an upper surface 712, alower surface 714, a graft opening 720, and notches 717 for receivingarms or extensions 770 of the plate member 750. The plate member 750also includes one or more windows 772 in its extensions 770 forreceiving a raised or bump out portion of the spacer 705, therebyhelping to retain the spacer 705 within the plate member 750. Inaddition, the plate member 750 includes stabilizers 763 in the form ofknife-like edges that help to grip into a vertebral body.

In addition to these features, the spacer 710 has a unique multi-piececomposition. As shown in FIGS. 18A and 18D, in some embodiments, thespacer 710 has a body formed of two adjacent members—a first member 711and a second member 713. The first member 711 and the second member 713can be held together via one or more pin members, although in otherembodiments, the first member 711 and second member 713 can be held viaadhesive, mateable connections, etc. As shown in FIG. 18D, second member713 can include an upper overhang region 717 that hangs over a part ofthe first member 711. Similarly, first member 711 can include a loweroverhang region 711 that hangs below a part of the second member 713.Advantageously, these overhang regions 711 serve as guides to identifythe location of the interface 715 between the first member 711 and thesecond member 713. During manufacturing, the overhang regions 711 makeit easy to inspect the interface to 715 to ensure that the two members711, 713 are properly secured together. While the illustrated embodimentshows a spacer 710 having two separate overhanging regions, in otherembodiments, the spacer 710 can have one single overhanging region. Asbefore, the spacer 710 can be made of many different types of materials,including bone (e.g., allograft) and PEEK), and a surgeon canadvantageously decide what type of spacer should accompany the platebefore or during surgery.

FIG. 19 shows a plating system 805 having a plate member 850 havingextensions 870 and a spacer 810 similar to that found in FIGS. 18A-18D;however, the spacer 810 is designed to accommodate lordosis. In otherwords, while the upper surface 712 and lower surface 714 of the spacer710 can be substantially parallel (as shown in FIG. 18C), the uppersurface 812 and lower surface 814 of the spacer 810 can have some degreeof angulation or lordosis. In some embodiments, relative to a mid-lineof the spacer 810, the upper surface 812 and/or lower surface 814 canhave a degree of angulation of 2, 3, 5, 7, 12 degrees or more.Advantageously, the lordotic spacer 810 (which is accompanied with theplate member 850) helps to accommodate different anatomies.

FIGS. 20A-20D show yet another alternative plating system having a platemember attached to multiple spacers in accordance with embodiments ofthe present application. The unique plating system 905 comprises a platemember 950 having a pair of inner arms or extensions 975 and a pair ofouter arms or extensions 970 for receiving one or more spacers 910therein. In some embodiments, both the inner and outer extensions 975,970 include protruding portions designed to be received in notches inthe one or more spacers.

As shown in FIG. 20A, the plating system 905 includes a first spacer 910a that is retained between a shorter outer extension 970 and a longerinner extension 975 of the plate member 950. The shorter outer extension970 of the plate is configured to be received in notch 917 of the spacer910 a, while the longer inner extension 975 of the plate is configuredto be received in notch of the spacer 910 a. In addition,advantageously, the shorter outer extension 970 includes a window 972and the longer inner extension 975 includes a window 974. Each of thewindows 972, 974 is configured to receive a bump out portion of thespacer 910, thereby helping to retain the spacer 910 to the plate member905. In addition, the windows 972, 974 help to provide a means tovisualize fusion (e.g., in a lateral image) that is occurring once thespacer is implanted within a disc space. Similarly, the plating system905 includes a second spacer 910 b that is retained between a shorterouter extension 970 and a longer inner extension 975 on an opposite sideof the plate member 950. While in the present embodiment, each of thelonger inner extensions 975 is separated from the other without anyconnecting member, in other embodiments, a connection bar or bridge(such as shown in FIGS. 21A and 21B) can extend between the two innerextensions 975. Advantageously, when the plating system 905 is placed ina disc space, graft material can be packed between the two innerextensions 975 to promote fusion within the disc space.

Advantageously, in accordance with some embodiments, the plating system905 is designed to hold at least two spacers 910 a, 910 b. In someembodiments, the spacers 910 a, 910 b are substantially rectangularpieces. In some embodiments, the spacers 910 a, 910 b can havesubstantially rounded edges. In some embodiments, the spacers 910 a, 910b can include one or more chamfers 918 for providing clearance for oneor more screws that are inserted through the plate member 905. Forexample, spacer 910 a can include a chamfer that provides clearance fora screw that passes through plate opening 954, while spacer 910 b caninclude a chamfer that provides clearance for a screw that passesthrough plate opening 952. Advantageously, the use of two spacers 910 a,910 b—one on each side of the plate system 905—helps to stabilize theplate system within the disc space. Moreover, having multiple individualspacers 910 a, 910 b that are smaller in size can ease manufacturingissues, as the spacers can be formed of relatively small pieces of bone,which can be easier to find than larger pieces of bone. In other words,bone that is removed from a body can improve the yield of production, asit will be easier to create the spacer members. While the spacers 910 a,910 b are illustrated as being single-bodied members in the presentembodiments, in other embodiments, the spacers can be formed of multiplepieces (e.g., pinned together).

FIGS. 21A and 21B illustrate different views of another alternative lowprofile plate attached to multiple spacers according to someembodiments. The plate system 1005 comprises a plate member 1050attached to a pair of spacers 1010 a and 1010 b. Like the embodiment inFIG. 20A, the plate member 1050 of the present embodiment includes apair of outer arms or extensions 1070 a, 1070 b and a pair of inner armsor extensions 1075 a, 1075 b. Plate extensions 1070 a and 1075 a areconfigured to retain spacer 1010 a, while plate extensions 1070 b and1075 b are configured to retain spacer 1010 b. As shown in FIGS. 21A and21B, the inner extensions 1075 a and 1075 b includes a connection orbridge member 1088 that extends between them. Advantageously, the bridgemember 1088 helps provide added stability to the plate system 1005, andalso helps provide a barrier to retain graft material within the platesystem 1005. As shown in FIG. 21A, in some embodiments, the innerextensions 1075 a and 1075 b are parallel to one another.

As shown in FIG. 21B, outer plate extensions 1070 a and 1070 b includeat least one window 1072 formed therein. Similarly, inner plateextensions 1075 a and 1075 b include at least one window formed therein.As shown in FIG. 21B, inner plate extensions each include two windows—1074 and 1075—that are formed adjacent to one another. Inner plateextension 1075 a includes windows 1074 a and 1075 a, while inner plateextension 1075 b includes windows 1074 b and 1075 b. In someembodiments, the windows 1072, 1074, 1075 can advantageously be designedto hold a bump out portion of the spacers and/or provide increasedvisualization to a surgeon during or after a fusion procedure. While insome embodiments, each of the windows 1072, 1074, and 1075 perform thesame duties and functions, in other embodiments, the windows can performdifferent functions. For example, while inner window 1074 can be used toboth retain the spacer and aid in fusion visualization, inner window1075 can be used simply for fusion visualization.

FIG. 22 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments. The plate system 1105comprises a plate member 1150 attached to a pair of spacers 1110 a and1110 b. Like the embodiment in FIG. 21A, the plate member 1150 of thepresent embodiment includes a pair of outer arms or extensions 1170 a,1170 b and a pair of inner arms or extensions 1175 a, 1175 b. Plateextensions 1170 a and 1175 a are configured to retain spacer 1110 a,while plate extensions 1170 b and 1175 b are configured to retain spacer1110 b. As shown in FIGS. 21A and 21B, the inner extensions 1175 a and1175 b includes a connection or bridge member 1188 that extends betweenthem. Advantageously, the bridge member 1188 helps provide addedstability to the plate system 1105, and also helps provide a barrier toretain graft material within the plate system 1105. In contrast to theinner extensions 1075 a, 1075 b in FIG. 21A, the inner extensions 1175a, 1175 b are non-parallel and angulated relative to one another.Furthermore, due to the shape of the plate member 1150, the shapes ofthe individual spacers 1110 a and 1110 b differ in that they have aprominent angled surface adjacent to the inner extensions 1175 a, 1175b.

FIG. 23 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments. The plate system 1205comprises a plate member 1250 attached to a pair of spacers 1210 a and1210 b. Like the embodiment in FIG. 22, the plate member 1250 of thepresent embodiment includes a pair of outer arms or extensions 1270 a,1270 b and a pair of inner arms or extensions 1275 a, 1275 b. Plateextensions 1270 a and 1275 a are configured to retain spacer 1210 a,while plate extensions 1270 b and 1275 b are configured to retain spacer1210 b. As shown in FIG. 23, the inner extensions 1275 a and 1275 bincludes a connection or bridge member 1288 that extends between them.Advantageously, the bridge member 1288 helps provide added stability tothe plate system 1205, and also helps provide a barrier to retain graftmaterial within the plate system 1205. In contrast to the bridge member1188 in FIG. 22, the bridge member 1288 is elongated and extends to adistal end of the spacers 1210 a, 1210 b, thereby creating an evenlarger space for receiving graft material in the middle of the platesystem 1205.

FIGS. 24A-24C illustrate another alternative low profile plate attachedto multiple spacers according to some embodiments. The plate system 1305comprises a plate member 1350 attached to a multi-piece spacer 1310formed of three members 1310 a, 1310 b, 1310 c. Like the embodiment inFIG. 23, the plate member 1350 of the present embodiment includes a pairof outer arms or extensions 1370 a, 1370 b and a pair of inner arms orextensions 1375 a, 1375 b connected by a bridge member 1388. The innerextensions 1375 a, 1375 b and bridge member 1388 are configured to beenclosed by the body of the spacer 1310. Advantageously, the bridgemember 1388 helps provide added stability to the plate system 1305, andalso helps provide a barrier to retain graft material within the platesystem 1305.

In some embodiments, the spacer 1310 is formed of three differentmembers 1310 a, 1310 b, 1310 c. The members 1310 a and 1310 b can beouter members which bound the inner member 1310 c. As shown in FIG. 24C,the members 1310 a and 1310 b can be substantially similar, and caninclude upper and lower surfaces with surface protrusions to enablebetter gripping of bone. Inner member 1310 c can be different from theother members and can include a relatively smooth surface withoutsurface protrusions. In addition, the inner member 1310 c can be of adifferent height than the other members. In some embodiments, the threemembers 1310 a, 1310 b, 1310 c are pinned together, while in otherembodiments, they can be joined together via an adhesive or mateableconnection. Advantageously, the addition of the inner member 1310 cprovides further support to the overall structure of the plate system1305.

FIGS. 25A and 25B illustrate another alternative low profile plateattached to a multi-piece spacer having a metal insert according to someembodiments. The plate system 1405 comprises a plate member 1450attached to a multi-piece spacer 1410 formed of two similar components1410 a, 1410 b and a metal insert 1439. The plate member 1450 caninclude a first screw opening, a second screw opening and a rotatablelocking mechanism 1456 to prevent back out of screws that are insertedthrough the openings. In some embodiments, the plate member 1450 of thepresent embodiment is mounted to the front of the spacer. In otherembodiments, the plate member 1450 includes a pair of outer arms orextensions and/or a pair of inner arms or extensions (not shown) to helpretain the spacer 1410 within the plate member 1450.

In some embodiments, the spacer 1410 is formed of two members 1410 a and1410 b separated by a metal insert 1439. These members partially enclosea graft opening 1420. The two members 1410 a and 1410 b can be formed ofa material different from the metal insert 1439, such as PEEK.Advantageously, the metal insert 1439 is designed to provide additionalstrength to the spacer 1410. In some embodiments, the metal insert 1439is formed of titanium. As shown in the exploded view in FIG. 25B, thespacer 1410 be attached to the plate member 1450 via vertical fasteningmembers 1429 a, 1429 b. One skilled in the art will appreciate that thespacer 1410 can be used with any of the other plate members discussedabove.

FIGS. 26A-26D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments. The plate 1550 and spacer 1510 have many similar featuresas in prior embodiments; however, the upper screw hole 1552 in the plate1550 has been raised, while the lower screw hole 1554 in the plate 1550has been lowered. The upper screw hole 1552 has been raised such that acenter axis of the upper screw hole 1552 is positioned entirely above anupper surface 1512 of the spacer 1510. The lower screw hole 1554 hasbeen lowered such that a center axis of the lower screw hole 1554 ispositioned entirely below a lower surface 1514 of the spacer 1510.Advantageously, by raising the upper screw hole 1552 such that a centeraxis extends completely above the upper surface 1512 of the spacer 1510,this provides a plate member 1550 having increased visibility on itsupper end and also provides an upper plate portion that can be uniquelypositioned relative to a disc space, as shown in FIG. 28. Likewise, bylowering the lower screw hole 1554 such that a center axis extendscompletely below the lower surface 1514 of the spacer 1510, thisprovides a plate member 1550 having increased visibility on its lowerend and also provides a lower plate portion that can be uniquelypositioned relative to a disc space, as also shown in FIG. 28.

In some embodiments, the plate 1550 and the spacer 1510 have manysimilar features as in prior embodiments. For example, the spacer 1510is configured to have a body having an upper surface 1512 in contactwith an upper vertebral body and a lower surface 1514 in contact with alower vertebral body. The spacer body includes notches for receivingportions of the plate 1550 therein. In some embodiments, the spacer 1510is formed of a natural material, such as allograft bone.

The plate 1550 includes the upper screw hole 1552 and the lower screwhole 1554, and a pair of arms or extensions that are designed to bereceived within the spacer 1510. As noted above, the upper screw hole1552 has been raised such that a center axis that extends through theupper screw hole 1552 is positioned higher than an upper surface of thespacer 1510. In some embodiments, only a portion of the center axisthrough the upper screw hole 1552 is positioned higher than an uppersurface of the spacer 1510, while in other embodiments, the entirecenter axis through the upper screw hole 1552 is positioned higher thanan upper surface of the spacer 1510. Likewise, the lower screw hole 1554has been lowered such that a center axis that extends through the lowerscrew hole 1554 is positioned lower than a lower surface of the spacer1510. In some embodiments, only a portion of the center axis that passesthrough the lower screw hole 1554 is positioned lower than a lowersurface of the spacer 1510, while in other embodiments, the entirecenter axis through the lower screw hole 1552 is positioned lower than alower surface of the spacer 1510.

In some embodiments, the plate 1550 includes an upper extension, eyelidor rim 1571 through which the upper screw hole 1552 can pass through. Insome embodiments, the upper rim 1571 has an anterior or front face 1553and a posterior or back face 1555 (identified in FIG. 26C). In someembodiments, both the front face 1553 and the rear face 1555 of theupper rim 1571 are straight and vertical and not angled relative toheight of vertical axis of the spacer. In other embodiments, either thefront face 1553 or the rear face 1555 can be straight, while the otherface can be angled (e.g., in an anterior direction). In yet otherembodiments, both the front face 1553 and the rear face 1555 of theupper rim 1571 can be angled. Advantageously, in some embodiments, theupper screw hole 1552 extends through the upper rim 1571 at an anglesuch that a screw that is inserted through the upper screw hole 1552will be inserted at or near a corner edge of an upper vertebral body (asshown in FIG. 28). By being positioned at or near a corner edge of theupper vertebral body, it is not necessary for the screw to be positionedthrough an anterior face or aspect of the upper vertebral body, therebymaintaining a low profile implant. In some embodiments, the majority orentirety of the upper rim 1571 including the upper screw hole 1552 canbe configured such that the upper portion of the plate rests at or neara corner edge of the upper vertebral body, thereby maintaining a lowprofile implant.

In some embodiments, the plate 1550 includes a lower extension, eyelidor rim 1573 through which the lower screw hole 1554 can pass through. Insome embodiments, the lower rim 1573 has an anterior or front face 1553and a posterior or back face 1555 (identified in FIG. 29A). In someembodiments, both the front face 1553 and the rear face 1555 of thelower rim 1573 are straight and vertical and not angled relative toheight of vertical axis of the spacer. In other embodiments, either thefront face 1553 or the rear face 1555 can be straight, while the otherface can be angled (e.g., in an anterior direction). In yet otherembodiments, both the front face 1553 and the rear face 1555 of thelower rim 1573 can be angled. Advantageously, in some embodiments, thelower screw hole 1554 extends through the lower rim 1573 at an anglesuch that a screw that is inserted through the lower screw hole 1554will be inserted at or near a corner edge of a lower vertebral body (asshown in FIG. 28). By being positioned at or near a corner edge of thelower vertebral body, it is not necessary for the screw to be positionedthrough an anterior face or aspect of the upper vertebral body, therebymaintaining a low profile implant. In some embodiments, the majority orentirety of the lower rim 1573 including the lower screw hole 1554 canbe configured such that the lower portion of the plate rests at or neara corner edge of the lower vertebral body, thereby maintaining a lowprofile implant. Advantageously, in some embodiments, at least a portionof the upper rim 1571 and/or a portion of the lower rim 1573 ismaintained within the disc space between the upper vertebral body andthe lower vertebral body, thereby maintaining an implant with a lowprofile.

FIGS. 27A-27D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments. The plate 1550 and the spacer 1610 are similar to theassembly in FIGS. 26A-26D, except the spacer 1610 is formed of adifferent material, such as PEEK. Advantageously, the plate 1550 iscapable of being assembled with either the bone spacer 1510 shown inFIGS. 26A-26D or the PEEK spacer 1610 shown in FIGS. 27A-27D prior toinsertion into a disc space, thereby providing versatility to a surgeon.

FIG. 28 illustrates the plate and spacer in FIGS. 26A-26D in use withina vertebral space. From this view, one can see how the plate 1510 isdesigned to have an upper rim 1571 that accommodates an upper screw hole1552 and a lower rim 1573 that accommodates a lower screw hole 1554. Theupper screw hole 1552 receives an upwardly angled screw that isconfigured to be inserted at or near a corner of the upper vertebralbody, thereby avoiding insertion through an anterior face or aspect ofthe upper vertebral body. The lower screw hole 1554 receives adownwardly angled screw that is configured to be inserted at or near acorner of the lower vertebral body, thereby avoiding insertion though ananterior face or aspect of the lower vertebral body.

FIGS. 29A-29C illustrate the plate in FIGS. 26A-26D without a spacer. Asshown in these figures, the plate 1550 includes an upper rim 1571 thataccommodates an upwardly angled screw hole 1552 and a lower rim 1573that accommodates a downwardly angled screw hole 1554. The upper rim1571 includes a front or anterior face 1553 a and a rear or posteriorface 1555 a, while the lower rim 1573 includes a front or anterior face1553 b and a rear or posterior face 1555 b. As shown in FIG. 29B, insome embodiments, the entire anterior face of the plate (e.g., includingthe upper anterior face of the upper rim 1571 and the lower anteriorface of the lower rim 1573) can be straight and non-angled. In otherembodiments, portions of the anterior face can be slightly angled, suchas in an anterior direction. In addition, as shown in FIG. 29B, in someembodiments, portions of the posterior faces of the plate (e.g.,posterior faces 1555 a and 1555 b) can also be straight and non-angled.In other embodiments, portions of the posterior faces can be angled(e.g., in an anterior direction), such as 5 degrees, 10 degrees, 15degrees, or more. In some embodiments, the anterior and/or posteriorfaces of the rims can be angled between 5 and 15 degrees.

FIGS. 30A-30E illustrate different views of an allograft spacer 1510that can be used with the plate in FIGS. 26A-26D. The allograft spacer1510 includes a notch 1517 for receiving extension members of the platetherein. FIGS. 31A-31E illustrate different views of a PEEK spacer 1610that can be used with the same plate. The PEEK spacer 1610 includes anotch 1617 for receiving extension members of the plate therein. Asnoted above, the surgeon can desirably choose which spacer to insertinto a surgical site.

FIGS. 32A and B illustrate different views of a spacer 1710 (eitherallograft or PEEK) for receiving extension members of the plate. Thespacer 1710 includes a pair of channels or notches 1717 for receiving anextension member from a plate. Each of the notches 1717 extends avertical distance from an upper surface of the spacer 1710 to a lowersurface of the spacer 1710.

In FIG. 32B, a single notch 1717 out of a pair of notches is visiblefrom the sideview. Each of the notches 1710 is comprised of twosidewalls 1721, 1723 that form a channel that extend from an uppersurface to a lower surface of the spacer 1710. In some embodiments, oneor more of the sidewalls 1721, 1723 can be straight with no angle orcurvature. However, in other embodiments, as shown in FIG. 31, one ormore sidewalls 1721, 1723 can have a curved portion. In the figure,first sidewall 1721 comprises a first curved portion 1722, while secondsidewall 1723 comprises a second curved portion 1724. Due to the curvedportions 1723, 1724, each of the notches 1710 can form a bent, curved ortortured channel for receiving an extension member of a plate therein.The advantage of having a tortured channel for receiving an extensionmember (such as any of the extension members 70 in FIG. 2D, 170 in FIG.6D, 670 in FIG. 16B, 870 in FIG. 19, 970 in FIG. 20B, etc), is that thisprovides a tighter fit between the respective plate member and thespacer. Should a plate-spacer system encounter any forces that mightcause slippage of the plate from the spacer, the tortured channel 1717reduces the likelihood that this will occur.

As shown in FIG. 32B, the first sidewall 1721 and the second sidewall1723 of the notch 1717 can include a straight upper portion, a curved orbent middle portion, and a straight lower portion. While the sidewalls1721, 1723 are shown as substantially or completely parallel to eachother in the figure, in other embodiments, the sidewalls 1721, 1723 neednot be aligned with one another, so long as the sidewalls form a bent ortortured path through the spacer.

FIGS. 33-40 illustrate the different views of an intervertebral spacer2010 according to the present disclosure. The intervertebral spacer 2010as shown in FIGS. 33-40 may be, e.g., a stand-alone anterior lumbarinterbody spacer used to provide structural stability in skeletallymature individuals following discectomies. These intervertebral spacersmay be available in various heights and geometric configurations to fitthe anatomically needs of a wide variety of patients. Specifically,FIGS. 33-40 illustrate one embodiment of an intervertebral spacer 2010.Intervertebral spacer 2010 may be generally positioned in theintervertebral space between two adjacent vertebral bodies. As shown inthe figures, intervertebral spacer 2010 may include a spacer portion2012 and a plate portion 2014. In one example, the spacer portion 2012may include a graft window 2011 for the placement of, e.g., bone graftor bone-growth inducing material, to enhance fusion between two adjacentvertebral bodies.

The spacer portion 2012 can be comprised of any material that isconducive to the enhancement of fusion between the two adjacentvertebral bodies. In one particular embodiment, the spacer portion 2012is made of PEEK material, which may be physiologically compatible. Itshould be noted that any other materials that are physiologicallycompatible also may be used. The spacer portion 2012 may includetantalum pins that enable radiographic visualization, or other suitableradiographic markers. The spacer portion 2012 further may includesuperior and inferior surfaces that are provided with a plurality ofgeometric configurations, such as, e.g., protrusions 2013 (e.g., ribs,bumps, other textures, or the like). The superior and inferior surfacesof the spacer portion 2012 may be bi-convex for greater contact with thevertebral endplates of the adjacent vertebral bodies. The protrusions2013 can be configured to be any size or shape for further anchoring thespacer portion 2012 to each of the adjacent vertebral bodies.Protrusions 2013 on the superior and inferior surfaces of each implantmay grip the endplates of the adjacent vertebral bodies to aid inexpulsion resistance.

The plate portion 2014 can also be comprised of any physiologicallycompatible material. In one example, the plate portion 2014 of theintervertebral spacer 2010 may be formed from titanium. The plateportion 2014 may include at least one bore 2026. In some embodiments,plate portion 2014 may include a plurality of bores 2026, in suchembodiments, one or more bores 2026 may or may not include threads forreceiving corresponding threads on a fastener. That is to say, in someexamples, one or more of bores 2026 may interact with features (e.g.,threads) configured to receive features (e.g., corresponding threads) ofa fastening member (e.g., a linear bone screw) to be disposedtherethrough. Bores 26 may be substantially linear. Such a configurationallows bores 2026 to receive both linear fastening members andcurvilinear fastening members. That is, a given bore 2026 may beconfigured to receive either a linear fastening member (e.g., a screw)or a curvilinear fastening member (as discussed below in greater detail)at the discretion of an operator, surgeon, physician, or the like. Inone embodiment, e.g., bores 2026 may include one or more features, e.g.,threads, that are configured to engage with threads of a fasteningmember (e.g., a linear fastening member or bone screw). Further, in someexamples, a curvilinear fastening member disposed through a given bore2026 may be configured so as not to engage the threads of the given bore2026. Still further, each bore 2026 may include locking featuresconfigured to engage with complimentary features on a curvilinearfastening member to prevent the curvilinear fastening member fromrotating when disposed through the bore 2026. In one example, each bore2026 may be defined by a circumferential wall having a recess (notshown) disposed therein. The recess may be configured to receive aprotrusion extending from the curvilinear fastening member to preventthe curvilinear fastening member from rotating. In one example, threebores 2026 may be provided. In yet another example, two outer bores 2026may surround a central bore 2026. The two outer bores 2026 may be angledto guide a fastening member (e.g., a vertebral anchor 2300 describedwith reference to FIGS. 61-68, or a bone screw) along a first trajectory2040 shown in FIG. 46 (e.g., toward one of a superior or inferiorsurface of intervertebral spacer 2010), while the central bore 2026 maybe angled to guide a fastening member along a second trajectory 2042(e.g., toward the other of the superior and inferior surface ofintervertebral spacer 2010), and vice versa. In some examples, all bores2026 may guide respective fasteners along the same trajectory. The bores2026 can accommodate a straight longitudinal fastening member (e.g., ascrew, pin, or the like) and/or a fastening member exhibiting acurvature (e.g., vertebral anchor 2300 shown in FIG. 61). In someexamples, a combination of vertebral anchors 2300 and conventionalscrews may be used to install the same intervertebral spacer 2010.

Also, in the plate portion 2014 of the intervertebral spacer 2010, afastener back out prevention mechanism may be provided. The fastenerback out prevention mechanism may include one or more screws 2016, eachhaving a head portion 2024 and a shank 2022 having threads 2022 a. Shank2022 may be received by a bore 2048 (shown in FIG. 40) that extends froma first side 2044 of plate portion 2014 toward a second side 2046 ofplate portion 2014. Shank 2022 also may be received by a nut 2018 havinga threaded bore 2018 a (shown in FIG. 33). Nut 2018 may have asubstantially rectangular cross-section, or may have another suitableshape. Nut 18 may be secured within a recess 2020 on second side 2046 ofplate portion 2014. However, it is contemplated that screws 2016 may besecured to plate portion 2014 by any other suitable mechanism. Headportion 2024 may have a generally rectangular cross-section such that itmay prevent a fastening member from backing out of bores 2026 whendisposed in certain configurations (e.g., a blocking configuration). Forexample, referring to FIG. 40, the head portion 2024 of screw 2016 mayextend over, cover, and/or block at least a portion of the opening ofone more of bores 2026, preventing a fastening member (e.g., a vertebralanchor 2300 or a bone screw) extended through a bore 2026 from backingout of plate portion 2014 and a vertebral body. It is also contemplatedthat in some examples, a single head portion 24 may extend at leastpartially over two adjacent bores 2026 (e.g., both an outer bore 2026and a central bore 2026), thereby blocking the openings of more than onebore 2026 at the same time while disposed in a blocking configuration.Head portion 2024 can be moved from the blocking configuration to anon-blocking configuration by rotating head portion by, e.g., 90 degreesor another suitable measure. While depicted as rectangular, it iscontemplated that head portion 2024 may be formed in other suitableelongate shapes, such as, e.g., cylindrical or the like. In the exampleof FIG. 8, plate portion 2014 may be configured to receive two screws2016 in bores 2048 (shown in FIG. 40). Each of the screws 2016 may beconfigured to block fastening members disposed in an outer bore 2026 anda central bore 2026, such that each outer bore 2026 is blocked by asingle screw 2016, and the central bore 2026 is blocked by both screws2016.

A coupling mechanism may connect the spacer portion 2012 and the plateportion 2014 rigidly to each other, if desired. With reference to FIG.34, the coupling mechanism may include one or more fastening members2034 that extend through corresponding recesses 2036 disposed throughspacer portion 2012 and recesses 2038 disposed through at least aportion of plate portion 2014. In one example, a fastening member 2026may extend through the superior and inferior surfaces of spacer portion2012 (via a recess 2036) and may be received by recess 38 of plateportion 2014, thereby coupling spacer portion 2012 and plate portion2014. It is contemplated that recess 2038 and fastening member 2026 mayinclude complimentary mating features (e.g., threads) to facilitatecoupling of plate portion 2014 to spacer portion 2012. In the exampleshown in FIG. 34, plate portion 2014 may be formed by three boresections 2028, 2030, and 2032. Bore sections 2028, 2030, and 2032 mayeither be integrally formed or detachable with spacer portion 2012. Inone example, bore section 2028 may be integral with spacer portion 2012while bore sections 2030 and 2032 may be detachable with spacer portion2012 via fastening members 2034 and recesses 2036 and 2038. In oneexample, the detachable bore sections 2030 and 2032 may include theouter bores 2026 that are configured to direct a vertebral anchor 2300or bone screw along the first exit trajectory 2040, and the bore section2028 may include the central bore 2026 configured to direct a vertebralanchor 2300 or bone screw along the second exit trajectory 2042.Further, one or more of the bore sections 2028, 2030, and 2032 mayinclude a portion configured to extend through a slot of or otheropening in spacer portion 2012. In such examples, the recesses 2036,2038, or the like associated with the bore sections may align withrecesses formed through spacer portion 2012 to receive fastening members2034.

Plate portion 2014 also may include coupling features for coupling plateportion 2014 to an anchor insertion device 2100 which will be describedfurther with reference to FIGS. 42-55. As shown in FIG. 40, plateportion 2014 may include a channel (e.g., a snap-fit channel) 2050having an opening disposed in an outer surface of plate portion 2014.The channel 2050 may be configured to receive an extension (e.g., acantilever and/or snap-fitting extension) of anchor insertion device2100 to couple plate portion 2014 to the insertion device 2100. In someexamples, channel 2050 may be disposed in bore section 2030 of plateportion 2014. With continuing reference to FIG. 40, channel 2050 mayhave a generally ovular opening, although other suitable openingconfigurations such as, e.g., circular, square, rectangular,star-shaped, or the like are also contemplated. Plate portion 2014 alsomay include a bore 2052 (e.g., a threaded bore) having an opening thatis also disposed through an outer surface of plate portion 2014. In oneexample, bore 2052 may be disposed through bore section 2032 of plateportion 2014.

In an exemplary method, a physician, surgeon, or other suitable operatormay remove, among other things, the native intervertebral disc betweentwo vertebral bodies. The operator then may select a givenintervertebral spacer, e.g., intervertebral spacer 2010, to replace theremoved native intervertebral disc. Based on the geometry of thesurrounding vertebral bodies and/or anatomy, the operator may determinethat linear fastening members (e.g., linear bone screws), curvilinearfastening members (e.g., vertebral anchors 2300 or 2400), or acombination of linear fastening members and curvilinear fasteningmembers, will provide optimal fit and securement of intervertebralspacer 2010 between the vertebral bodies. For example, the curvature ofthe spine at one or more of the vertebral bodies may substantiallyinhibit the use of the tools and driving members used to install linearfastening members. In such examples, curvilinear fastening members maybe selected to secure intervertebral spacer 2010. The curvilinearfastening members may be installed through the same linear bore 2026that may be configured to receive linear fastening members. Further, thecurvilinear fastening members may be installed through the linear borewith a positioning member (described with reference to FIG. 42)utilizing a guide member that can be extended only along a linear track.

In one example, one or more curvilinear fasteners may be used to secureintervertebral spacer 2010 to one vertebral body defining anintervertebral space, while one or more linear fasteners may be used tosecure intervertebral spacer 2010 to the other vertebral body definingthe intervertebral space. For example, curvilinear fasteners may beextended through outer bores 2026 while a linear fastener is extendedthrough central bore 2026. Alternatively, linear fastening members maybe extended through outer bores 2026 while a curvilinear fasteningmember is extended through central bore 2026. In yet another example,both linear and curvilinear fastening members may be used to secure thesame intervertebral spacer into a given vertebral body. That is, acurvilinear fastening member may be extended through one outer bore2026, while a linear fastening member is extended through the otherouter bore 2026.

FIG. 41 depicts an intervertebral spacer 2090 in accordance with anexample of the present disclosure. In some examples, intervertebralspacer 2090 may be substantially similar to intervertebral spacer 2010,or may be another suitable intervertebral spacer. In the example shownin FIG. 41, spacer 2090 may be a generally rectangular spacer defining acavity 2091. Cavity 2091 may be packed with bone graft or bone-growthinducing materials. Spacer 2090 may include one or more of inferiorsurfaces, superior surfaces, biconvex surfaces, among others. In someexamples, the surfaces of spacer 2090 or any other bone contactingsurface described in the present disclosure may include one or more ofteeth, ridges, friction increasing elements, keels, or gripping orpurchasing projections.

Spacer 2090 may include a plate portion 2092 that may include one ormore features described with reference to plate portion 2014 ofintervertebral spacer 2010. In one example, one or more bores 2093 maybe disposed through plate portion 2092. Though FIG. 41 depicts two bores2093, those of ordinary skill in the art will recognize that anysuitable number of bores may be provided. Bores 2093 may include one ormore features described with reference to bores 2026 of intervertebralspacer 2010. The two bores 2093 may be angled to guide a fasteningmember (e.g., a vertebral anchor 2300 or a bone screw) along differingtrajectories. For example, one bore 2093 may be angled to urge afastening member along a first trajectory (e.g., toward one of asuperior or inferior surface of intervertebral spacer 2090), while theother bore 2093 may be angled to urge a fastening member along a secondtrajectory (e.g., toward the other of the superior and inferior surfaceof intervertebral spacer 2090). The bores 2093 can accommodate astraight longitudinal fastening member (e.g., a screw, pin, or the like)and/or a fastening member exhibiting a curvature (e.g., vertebral anchor2300 or 2400). In some examples, a combination of vertebral anchors 2300or 2400 and conventional screws may be used to install the sameintervertebral spacer 2090 as shown in FIG. 57. A circumferential walldefining bores 2093 may further include one or more recesses 2094disposed therein. The one or more recesses 2094 may be configured toreceive one or more protrusions 2460 disposed on a head portion 2406 ofa vertebral anchor 2400 (described with reference to FIGS. 69-72). Thus,in some examples, recesses 2094 may be partially-spherical to receiveprotrusions 2460. However, it is contemplated that recesses 2094 may beformed in any suitable shape configured to receive protrusions 2460.Plate portion 2092 also may include a bore 2095 having an opening thatis disposed through an outer surface of plate portion 2092. The bore2095 may include one or more features, e.g., threads or other featuresto engage with an insertion device 2200 described with further detailbelow. Intervertebral spacer 2090 also may include one or more featuresconfigured to prevent fastening members from backing out of bores 2093,such as, e.g., screws 2016 described with reference to FIGS. 33-40.

Intervertebral spacer 2090 may be inserted into an intervertebral spacebetween two vertebral bodies in a substantially similar manner asintervertebral spacers 2010. In one example, one or more curvilinearfasteners may be used to secure intervertebral spacer 2090 to onevertebral body defining an intervertebral space, while one or morelinear fasteners may be used to secure intervertebral spacer 2090 to theother vertebral body defining the intervertebral space. For example, acurvilinear fastener may be extended through one bore 2093 while alinear fastener is extended through the other bore 2093.

An insertion device 2100 is shown in FIG. 42, which may be used toposition vertebral anchors 2300 through a plate portion of anintervertebral spacer (e.g., plate portion 2014 of intervertebral spacer2010) and through a vertebral body. Insertion device 2100 may extendfrom a trailing end 2102 toward a leading end 2104. A trailing housing2106 may be disposed at trailing end 2102 and may define one or moreelongate channels 2108. In the embodiment shown, three elongate channels2108 are shown, although any other suitable number of elongate channels2108 may be disposed through trailing housing 2106. Each of elongatechannels 2108 may receive a guide member 2110 therethrough. Guide member2110 may include a head portion 2112 and an elongate portion 2114 thatextends away from the head portion 2112. In some examples, head portion2112 may include one or more flattened and reinforced surfacesconfigured to receive the force of a striking member (e.g., a hammer orthe like). Elongate portion 2114 may be extended through one or moreelongate channels 2108 toward leading end 2104. The distal or leadingend of elongate portion 2114 may include a stepped portion 2132 (shownin FIG. 50). Stepped portion 2132 may be separated from the remainder ofelongate portion 2114 by a vertical wall 2130. In some examples, steppedportion 2132 may include a smaller cross-sectional dimension (e.g.,thickness or width) as compared to a remainder of elongate portion 2114.

A connecting housing 2115 may extend from trailing housing 2106 towardan anchor housing 2116 disposed at leading end 104. In some examples,connecting housing 2115 may be an alignment shaft configured to alignelongate channels 2108 with a corresponding number of anchor channels2118 (see FIG. 43) disposed in anchor housing 2116. In the embodimentshown in FIG. 42, connecting housing 2115 may extend from only one ofelongate channels 2108 to couple trailing housing 2106 to anchor housing2116. However, those of ordinary skill in the art will appreciate that ashaft 2116 may extend from more than one elongate channel 2108 towardanchor housing 2116. Guide member 2110 may extend through an elongatechannel 2108, through connecting housing 2115, and into an anchorchannel 2118, where it may come into contact with a vertebral anchor2300 just before inserting the vertebral anchor 2300 through a vertebralbody, as described further with reference to FIGS. 50-55. In someexamples, connecting housing 2115 may merely align certain elongatechannels 2108 in trailing housing 2106 with anchor channels 2118disposed in anchor housing 2116. In such examples, elongate portion 2114of guide member 2110 may exit a leading end of elongate channel 2108 andextend through an open and unconfined space before entering a trailingend of an anchor channel 2118.

As best seen in FIG. 43, anchor housing 2116 may include one or moreanchor channels 2118. Each anchor channel 2118 may have a variablecross-section along the length of anchor housing 2116. In some examples,a given cross-section of anchor channel 2118 may be t-shaped or anyanother suitable cross-section. A curvature at the leading end of anchorchannel 2118 may be complimentary to certain portions of a curvilinearanchor (e.g., anchor 2300 shown in FIG. 61). Those portions may includean elongate shank 2308 and elongate fin 2310, shown in FIGS. 61 and 63.That is, anchor channel 2118 may be defined by a concave surface 2119that is complimentary to elongate shank 2308 of vertebral anchor 2300.For example, a laterally extending portion 2148 of each channel 2118 maybe configured to complement and receive a curved elongate shank 2308,and a vertically extending portion 2126 of each channel 2118 may receivea curved elongate fin 2310. Thus, a vertebral anchor 2300 may bedisposed within each anchor channel 2118 and may exit anchor channel2118 along a given exit trajectory. Some anchor channels 2118 may urge avertebral anchor 2300 along a first exit trajectory 2120 while otherexit channels 2118 may urge a vertebral anchor 2300 along a second exittrajectory 2122. First exit trajectory 2120 may extend in a firstvertical direction out of the leading end of anchor housing 2116 whilethe second, different exit trajectory 2122 may extend in a secondvertical direction out of the trailing end of anchor housing 2116. Agiven anchor housing 2116 may include a plurality of anchor channels2118 that may direct all vertebral anchors 2300 along the first exittrajectory 2120, all vertebral anchors 2300 along the second exittrajectory 2122, or some vertebral anchors 2300 along the first exittrajectory 2120 and some vertebral anchors 2300 along the second exittrajectory 2122. Each of first and second trajectories 2120 and 2122 mayintersect a longitudinal axis of insertion device 2100 and/or guidemember 2110. In one example, laterally adjacent anchor channels 2118 maybe configured to direct vertebral anchors 2300 along different exittrajectories. In the exemplary embodiment shown in FIGS. 43-46, anchorhousing 2116 may include three anchor channels 2118. Two outer anchorchannels 2118 may be laterally offset from an inner anchor channel 2118.The outer anchor channels 2118 may urge respective vertebral anchors2300 along first exit trajectory 2120 while the inner anchor channel2118 may urge a vertebral anchor 2300 along second exit trajectory 2122.Anchor channel 2118 may further include a stop wall 2146 (shown in FIGS.50-55) that may extend radially inward from a wall of anchor channel2118. Stop wall 2146 may be configured to abut a vertical wall ofelongate portion 2114 (of guide member 2110) to prevent elongate portion2114 from being inserted too far distally into a patient by an operator.Thus, stop wall 2146 also may prevent an inadvertent excessive forcefrom being applied to intervertebral spacer 2010 or to a vertebral bodyby elongate portion 2114.

Anchor housing 2116 may include one or more features to engage withcorresponding features disposed on plate portion 2014 of intervertebralspacer 2010. In one example, an extension 2117 (e.g., a hook fit, slipfit or cantilevered snap-fit extension 2117) may extend longitudinallyoutward from the leading end (e.g., a distal face) of anchor housing2116. Extension 2117 may include one or more surfaces configured toengage channel 2050 of plate portion 2014 in a snap fit or othersuitable engagement. Anchor housing 2116 also may include a threadedshank 2113 that extends longitudinally outward from the leading endfaceof anchor housing 2116. In some examples, threaded shank 2113 may bereceived by bore 2052 of plate portion 2014. While snap-fit and threadedconnections are disclosed in the examples shown by the figures, itshould be noted that any other additional or alternative type ofengagement may be utilized to couple anchor housing 2116 to plateportion 2014.

Anchor housing 2116 also may include one or more positioning members2138, as shown in FIG. 50. Each positioning member 2138 may secure avertebral anchor 2300 within a respective anchor channel 2118. Thus,each anchor channel 2138 may be associated with its own respectivepositioning member 2118. In one example, positioning member 2138 may bean elongate cantilever that is coupled to a leading end portion ofanchor housing 2116 via a linkage or hinge 2140. In some examples,linkage or hinge 2140 may be a spring-biased linkage or may be anothersuitable hinge or linkage. Positioning member 2138 may extend fromlinkage 2140 toward trailing end 2102. At its proximal or trailing end,positioning member 2138 may include a ramp 2142 and an extension 2144spaced from ramp 2142 by a recess. Ramp 2142 may be an inclined surfaceconfigured to engage elongate portion 2114 of guide member 2110.Positioning member 2138 may be configured to pivot about the linkage2140 and away from an interior of anchor channel 2118 when ramp 2142 isengaged by elongate portion 2114 of guide member 2110. In some examples,positioning member 2138 may pivot in a direction that is opposite to theexit trajectory of its associated anchor channel 2118. That is, if agiven anchor channel 2118 is configured to guide a vertebral anchor intoa vertebral body along first trajectory 2120, the associated positioningmember 2138 of that elongate channel may pivot about linkage 2140 in thevertical direction that is opposite to the vertical vector of firsttrajectory 2120. On the other hand, if a given anchor channel 2118 isconfigured to guide a vertebral anchor 2300 along the second trajectory2122, the associated positioning member 2138 of that anchor channel 2118may be configured to pivot in a vertical direction that is opposite tothe vertical vector of second trajectory 2122. Extension 2144 mayinclude any suitable configuration (e.g., a ball or the like), and maybe configured to be releasably coupled to a vertebral anchor 2300 viagroove 22318.

Vertebral anchors 2300 may be loaded into anchor channels 2118 prior tothe coupling of anchor housing 2116 to plate portion 14 ofintervertebral spacer 2010. Vertebral anchors 2300 may be loaded fromeither the trailing end or the leading end of anchor housing 2116, ifdesired. In some examples, vertebral anchors 2300 may be loaded by aspring-loaded block device. In one example, a vertebral anchor 2300 maybe loaded into the leading end of anchor housing 2116 with trailing end2302 of the vertebral anchor being inserted first. That is, trailing end2302 of vertebral anchor 2300 may be loaded into anchor channels 2118before leading end 2304. Thus, vertebral anchors 2300 may be loaded in areverse manner such that the vertebral anchors 2300 are loaded in theopposite direction to which they are inserted into the body. Asvertebral anchors 2300 are moved proximally through anchor channels2116, groove 2318 may be coupled to extension 2144 of positioning member2138. The docking, mating, or connection of extension 2144 with groove2318 may fix vertebral anchor 2300 within anchor channel 2118 untilvertebral anchor 2300 is inserted through a vertebral body. In oneexample, extension 2144 may be a ball and a groove 2318 of vertebralanchor 2300 may be a socket such that extension 2144 and groove 2318form a ball and socket joint. However, those of ordinary skill in theart will appreciate that any other suitable form of releasableconnection may be utilized.

Anchor housing 2116 may be coupled to intervertebral spacer 2010 toinstall vertebral anchors 2300 into the body. Anchor housing 2116 andplate portion 2014 may be aligned via extension 2117 and channel 2050,and/or via shank 2113 and bore 2052 in such a manner as to alignchannels 2118 of anchor housing 2116 with bores 2026 of plate portion2014. The alignment of channels 2118 and bores 2026 may permit one ormore vertebral anchors 2300 to be guided from a channel 2118 through acorresponding bore 2026 of plate portion 2014, and into a vertebralbody. Further, the anchor housing 2116 and plate portion 2014 may bealigned such that the exit trajectory of a given channel 2118 may bealigned (e.g., collinear or coplanar) with the exit trajectory of analigned bore 2026. In some examples, the number of channels 2118disposed in anchor housing 2116 may correspond exactly with the numberof bores 2026. However, it is contemplated that an exact correspondencemay not exist between channels 2118 and bores 2026. For example, ananchor housing 2116 may include fewer channels 2118 than bores 2026 in aplate portion. In such examples, anchor housing 2116 may be coupled toplate portion 2014 in a number of different configurations. In suchexamples, after a vertebral anchor 2300 is inserted through a vertebralbody, anchor housing 2116 may be uncoupled from plate portion 2014,reloaded with a new vertebral anchor 2300, and recoupled to plateportion 2014 at a different location.

With continuing reference to FIGS. 50-55, there is depicted an exemplarymethod of positioning a vertebral anchor 2300 via insertion device 2100.Referring to FIG. 50, vertebral anchor 2300 is shown loaded into ananchor channel 2118. The vertebral anchor 2300 may be secured within theanchor channel 2118 via the coupling of extension 2144 with groove 2318of the vertebral anchor 2300 as set forth above. Elongate portion 2114of guide member 2110 then may be advanced distally (e.g., in thedirection of leading end 2304) such that the distal end of elongateportion 2114 may contact ramp 2142 (FIGS. 51 and 52). In some examples,stepped portion 2132 of elongate portion 2114 may contact the ramp 2142.Elongate portion 2114 may be advanced further distally, causing ramp2142 to slide vertically upward, thereby disengaging extension 2144 fromgroove 2318 of vertebral anchor 2300 (FIG. 52). As elongate portion 2114is advanced further distally, the distal end of elongate portion 2114may abut the trailing end 2302 of vertebral anchor (FIG. 53). In someexamples, the stepped portion 2132 of elongate portion 2114 may abuthead portion 2306 of vertebral anchor 2300. Uncoupled from extension2144, vertebral anchor 2300 then may be advanced out of the leading endof anchor housing 2116 and anchor channel 2118 (FIG. 54) and ultimatelyinserted into a vertebral body (not shown) along a given exit trajectory(e.g., trajectory 2120 or 2122.), as shown in FIG. 55. After impactingone vertebral anchor 2300 through a vertebral body, the same guidemember 2110 (and elongate portion 2114) may be withdrawn and reinsertedthrough a different elongate channel 2108 and anchor channel 2118(having another preloaded vertebral anchor 2300), to impact a differentvertebral anchor 2300, if desired. Alternatively, each set of elongatechannels may include a dedicated guide member 2110.

One embodiment of an insertion device 2200 is shown in FIGS. 56-60.Insertion device 2200 may extend from a first, trailing end 2202 towarda second, leading end 2204. A base portion 2206 may include a proximalannular rim 2208 and base shaft 2209 extending therefrom. An alignmentshaft 2210 may extend from base shaft 2209. In the example shown in FIG.56 the leading end 2204 of alignment shaft 2210 may have a smallerdiameter than the trailing end of alignment shaft 2210, although othersuitable configurations, including a substantially constant diametershaft 2210, are also contemplated. In some examples, alignment shaft2210 may include one or more longitudinally extending windows 2218. Insome examples, alignment shaft 2210 may be a hollow elongate shaftaccommodating a drive mechanism 2216 therein. Drive mechanism 2216 maybe configured to actuate a coupling 2222 disposed at the leading end ofalignment shaft 2210. Drive mechanism 2216 may be a spring loaded driveshaft configured to reciprocally move coupling 2222 between a retractedconfiguration and an extended configuration. While in the extendedconfiguration, coupling 2222 may engage with, e.g., bore 2095 ofintervertebral spacer 2090 to couple insertion device 2200 tointervertebral spacer 2090. While coupling 2222 is engaged to bore 2095,drive mechanism 2216 may move coupling 2222 to the retractedconfiguration to disengage insertion device 2200 from intervertebralspacer 2090.

Coupling 2222 may be disposed in an anchor housing 2220 that is disposedat the leading end 2204 of alignment shaft 2210. Anchor housing 2220 mayinclude at least one anchor channel 2224. Anchor channel 2224 mayinclude one or more features described with reference to anchor channel2118 of insertion device 2100. For example, anchor channel 2224 may havea variable cross-section along its length and may have a concave surface2230 (shown in FIGS. 58-60) that is complimentary to, e.g., elongateshank 2408 of anchor 2400 shown in FIG. 69. For example, a laterallyextending portion of anchor channel 2224 may receive a curved elongateshank 2408. A guide member 2228 that may be substantially similar toguide member 2110 may be inserted through anchor channel 2224 to assistwith deploying an anchor disposed therein.

It is contemplated that insertion device 2200 may include additional oralternative features for attaching to intervertebral spacer 2090 suchas, e.g., positive attachments, cam attachments, threaded attachments orother suitable attachments. In some examples, pins or other members alsomay prevent the rotation of insertion device 2200 relative tointervertebral spacer 2090 when the insertion device 2200 andintervertebral spacer 2090 are engaged. In some examples, the leadingend of insertion device 2200 may couple to the anterior face, lateralsides, or other regions of intervertebral spacer 2090. In oneembodiment, the insertion device 2200 may include a stop that extends ineither the cephalad or caudal direction of a centerline of insertiondevice 2200 to prevent the intervertebral spacer 2090 from beinginadvertently impacted undesirably. That is, a stop may extend from thesuperior or inferior surface of insertion device 2200 and may contact,e.g., a surface of the intervertebral spacer or vertebral body.

Anchor housing 2220 may be coupled to an intervertebral spacer, e.g.,intervertebral spacer 2090, to install vertebral anchors 2400 into thebody. Anchor housing 2220 and plate portion 2092 may be aligned viacoupling 2222 and bore 2095, in such a manner as to align channel 2224of anchor housing 2220 with a bore 2093 of plate portion 2014. In someexamples, anchor channels 2224 may be laterally offset from the lengthof alignment shaft 2210. The alignment of channel 2224 and bore 2093 maypermit one or more vertebral anchors 2400 to be guided from a channel2224 through a corresponding bore 2093 of plate portion 2092, and into avertebral body. Further, the anchor housing 2220 and plate portion 2092may be aligned such that the exit trajectory of a given channel 2224 maybe inline (e.g., collinear or coplanar) with the exit trajectory of analigned bore 2093. While only one anchor channel 2224 is shown in theexample of FIGS. 56-60, it is contemplated that additional anchorchannels 2224 may be utilized (e.g., a double or multi-barreledconfiguration) such that the number of channels 2224 disposed in anchorhousing 2220 may correspond exactly with the number of bores 2093 invertebral spacer 2090. In some examples, a guide member may extendthrough one or more anchor channels 2224 to simultaneously insert one ormore fastening members (e.g., vertebral anchors or screws) through oneor more vertebral bodies. Other mechanisms of anchor insertion are alsocontemplated such as, e.g., a blocking set screw or leaf spring cutoutof the spacer or plate that is flexible in the insertion direction andstiff in the expulsion direction. An associated intervertebral spaceralso may include rotational stabilizers to add stability to theconstruct in vivo, and may contain radiographic markers to aid ininteroperative visibility.

FIGS. 58-60 depict an exemplary method of positioning a vertebral anchor2400 via insertion device 2200. Referring to FIG. 58, vertebral anchor2400 is shown loaded into an anchor channel 2224. The vertebral anchor2400 may be secured within the anchor channel 2224 by any suitablemechanism. Guide member 2228 then may be advanced distally such that thedistal end of guide member 2228 may contact head portion 2406 ofvertebral anchor 2400 (FIG. 58). Guide member 2228 may extend fromtrailing end 2202, through a trailing opening 2226 (shown in FIG. 57) ofanchor channel 2224 to abut a vertebral anchor 2400. Vertebral anchor2400 then may be advanced out of the leading end of anchor housing 2220and anchor channel 2224 (FIG. 59) and ultimately inserted into avertebral body (not shown) along a given exit trajectory, as shown inFIG. 60. After impacting one vertebral anchor 2400 through a vertebralbody, anchor housing 2220 may be disengaged from plate portion 2092, andanother vertebral anchor 2400 may be loaded into anchor channel 2224.When anchor channel 2224 is reloaded, anchor housing 2220 may bere-engaged with plate portion 2092 in a substantially similar manner asbefore, except that anchor channel 2224 may be aligned with a differentbore 2093 of vertebral spacer 2090.

A vertebral anchor 2300 shown in FIG. 2029 may extend from a first,trailing end 2302 toward a second, leading end 2304, and may include ahead portion 2306, an elongate shank 2308, and an elongate fin 2310.Vertebral anchor 2300 may be formed from a rigid, bio-compatiblematerial such as, e.g., titanium or polyetheretherketone (PEEK), amongothers. The head portion 2306, elongate shank 2308, and elongate fin2310 may be formed of the same or of different materials. Portions ofvertebral anchor 2300 may be treated with a titanium and/orhydroxyapatite plasma spray coating to encourage bony on-growth,improving the strength and stability of the connection between therespective component and the underlying bone (e.g., a vertebral body).Any other suitable coating also may be provided on one or more surfacesof vertebral anchor 2300. Such coatings may include therapeutic agents(e.g., antibiotic coatings), if desired. Vertebral anchor 2300 also mayinclude radiopaque markings to facilitate in vivo visualization andinsertion. Vertebral anchor 2300 may be configured to be impacted intovertebral bodies to secure implants within the intervertebral space of apatient. Vertebral anchor 2300 may be inserted into the patient andimpacted through the bone of a vertebral body.

The head portion 2306 may be disposed at trailing end 2302 of vertebralanchor 2300 and may be generally spherical or ball shaped. In someexamples, the head portion 2306 may be shaped in a substantially similarmanner as the head portion of other vertebral fastening members (e.g.,bone screws). In some examples, the head portion 2306 may include a bore2312 to facilitate removal of vertebral anchor 2300 from a vertebralbody. In some examples, bore 2312 may be a threaded bore or may includeother suitable features to facilitate the extraction of vertebral anchor2300 from a vertebral body by, e.g., a pulling tool or the like. In someexamples, a tool with a threaded tip may be rotated to threadinglyengage bore 2312, and the tool may be linearly withdrawn to extractvertebral anchor 2300 from within a vertebral body. The pooling toolalso may include one or more of a cam attachment, an expandable driver,or another feature for removing vertebral anchor 2300. A plurality ofslots or notches 2314 may be formed in the outer periphery of headportion 2306. In some examples, a plurality of flanges 2316 may definethe plurality of slots 2314 about the outer periphery of the headportion 2306. The flanges 2316 may be disposed around head portion 2306to form a generally t-shaped cross-section. A groove 2318 (e.g., asemi-cylindrical groove) may be formed in the outer periphery of headportion 2306. In some examples, the groove 2318 may be disposed withinone of the flanges 2316, or in another suitable location on head portion2306. In some examples, one or more grooves 2318 may be disposed alongthe periphery of head portion 2306. Groove 2318 may cooperate with anextension (e.g., extension 2144 shown in FIG. 50) of an installationdevice as discussed above. In some examples, the flanges 2316 and slots2314 of the head portion 2306 may cooperate with or be received bycomplimentary shaped features in a spacer, implant, plate system or thelike. The interaction between the flanges 2316, slots 2314, and thecomplimentary-shaped features may prevent the relative rotation ofvertebral anchor 2300 before, during and/or after installation ofvertebral anchor 2300 into a vertebral body.

Elongate shank 2308 may extend away from the head portion 2306 towardthe leading end 2304. In some examples, elongate shank 2308 may beplanar and may exhibit a curvature as it extends away from the headportion 2306. That is to say, in some examples, elongate shank 2308 mayinclude a curvilinear configuration. Specifically, elongate shank 2308may be curved (e.g., symmetrically curved) about a longitudinal axis.More specifically, elongate shank 2308 exhibit a curvature about amedian longitudinal axis. Further, the elongate shank 2308 may be curvedsuch that a concave surface 2320 and a convex surface 2322 extend fromtrailing end 2302 toward leading end 2304. The leading end of theelongate shank 2308 may be formed by a pair of inclined surfaces 2323and 2324 that extend from the lateral ends of elongate shank 2308 towardan apex 2326. Apex 2326 may be disposed on a longitudinal axis ofvertebral anchor 2300. Thus, at leading end 2304, elongate shank 2308may be formed as a projectile point, arrowhead, bladed edge, cuttingedge, or the like to facilitate impaction and insertion through boneand/or tissue. To reduce impaction force, the apex 2326 may feature ahollow style which may be similar to a knife edge. That is, the edge orapex 2326 of the anchor may approach a shallow angle, e.g.,approximately 15 degrees at the sharpest point, which may increasecloser to a central axis. In some examples, apex 2326 may be rounded toprevent injury, but may still be sharp around its edges. To furtherreduce insertion force and manufacturing time, the hollow surfaces maybe surface machined using, e.g., a 1 mm full radius mill and, e.g., a0.25 mm step-over, which may result in the wavy surface (including aplurality of rolling peaks and valleys) along the face of the hollowsurface. As further shown in FIGS. 61-68, inclined surfaces 2123 and2124 may include one or more geometric features, such as, e.g.,serrations (shown in FIG. 62), teeth, tapers, bevels or the like tofurther facilitate spearing, cutting, slicing, or impacting of elongateshank 2308 through bone and/or tissue. Inclined surfaces 2323 and 2324also may be formed with an edge (e.g., a v-edge, beveled edge, chiseledge, convex edge or the like) to facilitate impaction.

Elongate fin 2310 also may extend away from head portion 2306 toward theleading end 2304 of vertebral anchor 2300. Elongate fin 2310 also mayextend away from the concave surface 2320 of the elongate shank 2308.The vertical periphery of elongate fin 2310 may be defined by a concavesurface 2328. In some examples, the elongate shank 2308 and elongate fin2310 may be generally orthogonal to one another and may form a generallyt-shaped cross-section. The t-shaped cross-section formed by elongateshank 2308 and elongate fin 2310 may reduce impaction forces ofvertebral anchor 2300, and may increase the torsional stability ofvertebral anchor 2300 as compared to anchors having planarcross-sections. At leading end 2304, elongate fin 2310 may include aramped surface 2130 that extends toward apex 2326. Ramped surface 2330may include one or more of the geometrical features described withreference to inclined surfaces 2323 and 2324. In some examples, avertical periphery of ramp 2130 may be beveled and/or have a v-shapedcross-section.

Turning now to FIGS. 69-72, a further embodiment of a vertebral anchor2400 is depicted. Vertebral anchor 2400 may extend from a first,trailing end 2402 toward a second, leading end 2404, and may include ahead portion 2406, an elongate shank 2408, and an elongate fin 2428.Vertebral anchor 2400 may be formed from one or more of the materialsused to form vertebral anchor 2300 and may be treated with one or moresimilar coatings, if desired. Vertebral anchor 2400 may be inserted intoa patient and impacted through bone of a vertebral body.

The head portion 2406 may be disposed at trailing end 2402 of vertebralanchor 2400 and may have a partially spherical outer periphery. In someexamples, the head portion 2406 may be formed by a plurality ofspherical segments formed by removing one or more spherical caps fromthe spherical outer periphery of head portion 2406. In the embodimentsshown in FIGS. 69-72, at least three planar surfaces 2411, 2413, and2450 may define at least a portion of the outer periphery of thepartially-spherical head portion 2406. In one example, planar surfaces2411 and 2413 may be substantially parallel to one another, and may besubstantially orthogonal to planar surface 2450. In some examples,planar surface 2450 may define the proximal-most portion of head portion2406 and of vertebral anchor 2400. That is, planar surface 2450 maydefine the surface that is furthest toward trailing end 2402 ofvertebral anchor 2400. A recess (e.g., a concave recess) 2452 may bedisposed within planar surface 2450 such that planar surface 2450 may bedefined by interrupted hemispherical arc portions, as seen in FIG. 64. Abore 2412 may have an opening disposed within recess 2452. Bore 2412 mayextend through head portion 2406 and may include one or more featuresdescribed with reference to bore 2312 of vertebral anchor 2300. Whilenot shown in FIGS. 69-72, it is contemplated that head portion 2406 mayinclude other features described with reference to head portion 2306 ofvertebral anchor 2300, such as, e.g., grooves and/or mating featuresconfigured to secure and position vertebral anchor 2400 within an anchorchannel of an insertion device.

Head portion 2406 also may include one or more protrusions 2460 that mayextend away from the outer periphery of head portion 2406. In theexamples shown, protrusions 2460 may be formed as spherical caps (e.g.,partial domes), although protrusions 2460 may be formed in any othersuitable configuration. In some examples, the base of protrusions 2460may include an annular rim 2462 that may, e.g., extend radially awayfrom protrusions 2460. In some examples, head portion 2406 may includetwo protrusions 2460 that extend in opposite directions. It iscontemplated that another suitable number of protrusions 2460 may beemployed in alternative configurations.

Elongate shank 2408 may extend away from the head portion 2406 towardthe leading end 2404. In some examples, elongate shank 2408 may beplanar and may exhibit a curvature as it extends away from the headportion 2406. In some examples, elongate shank 2408 may be curved (e.g.,symmetrically curved) about a longitudinal axis. More specifically,elongate shank 2408 may exhibit a curvature about a median longitudinalaxis. Further, the elongate shank 2408 may be curved such that a concavesurface 2420 and a convex surface 2422 extend from trailing end 2402toward leading end 2404. The leading end of the elongate shank 2408 maybe formed by a pair of inclined surfaces 2423 and 2424 that extend fromthe lateral ends of elongate shank 2408 toward an apex 2426. Apex 2426may be disposed on a longitudinal axis of vertebral anchor 2400. In someembodiments, apex 2426 may include a curvilinear periphery. Thus, atleading end 2404, elongate shank 2408 may be formed to include any ofthe suitable geometries and features disposed on vertebral anchor 2300to facilitate impaction.

In one example, the lateral sides of elongate shank 2408 may include oneor more cutouts 2421. For example, each lateral side of elongate shank2408 may include two cutouts 2421 to form one or more keels 2425. Thekeels 2425 may generally extend and point in a reverse manner withrespect to a remainder of vertebral anchor 2400. That is, the end pointsof the keels 2425 may be oriented toward the trailing end 2402 and notleading end 2404. Thus, keels 2425 may assist in inhibiting vertebralanchor 2400 from exiting a vertebral body once inserted therein. In theembodiment shown in FIGS. 63-66, each lateral side of elongate shank2408 may include two cutouts 2421 and three keels 2425, although anyother suitable combination of cutouts and keels may be utilized.

One or more apertures 2427 may be disposed through the surface ofelongate shank 2408. Though depicted as through-holes, apertures 2427also may include blind recesses disposed in one or more surfaces ofelongate shank 2308. Once inserted through the bone of a vertebral body,apertures 2427 may encourage bony in-growth or on-growth therein,further securing vertebral anchor 2400 within a respective vertebralbody. In some examples, apertures 2427 may be packed with bone graft orother bone-growth inducing substances.

Elongate fin 2428 also may extend away from head portion 2406 toward theleading end 2404 of vertebral anchor 2400. Elongate fin 2428 also mayextend away from the concave surface of the elongate shank 2408. Thevertical periphery of elongate fin 2428 may be defined by one or morecutouts 2431 and keels 2435 in a substantially similar manner as thelateral sides of elongate shank 2408. In some examples, the elongateshank 2408 and elongate fin 2428 may be generally orthogonal to oneanother and may form a generally t-shaped cross-section. The t-shapedcross-section formed by elongate shank 2408 and elongate fin 2428 mayreduce impaction forces of vertebral anchor 2400, and may increase thetorsional stability of vertebral anchor 2400 as compared to anchorshaving planar cross-sections. At leading end 2404, elongate fin 2428 mayinclude a ramped surface 2430 that extends toward apex 2426. Rampedsurface 2430 may include one or more of the geometrical featuresdescribed with reference to inclined surfaces 2423 and 2424. In someexamples, apertures (not shown but similar to apertures 2427) may bedisposed on or through elongate fin 2428 to encourage bony in-growth oron-growth therein.

In some examples, vertebral anchors 2300 and 2400 may facilitate easyinsertion of various vertebral spacers (e.g., stand-alone ACDF and/orALIF spacers) through the use of inline impaction of anchors 2300 and2400 through the spacer. In some examples, the inline operation may befacilitated through appropriate implant design, instrument design, anddesign of the implant-instrument interface. In some examples, thevarious examples of the present disclosure may permit the use ofstand-alone spacers at the most caudal or most cephalad cervical discspaces (e.g., C5-C6/C6-C7 and C2-C3), and at the caudal lumbar levels(e.g., L5-S1) where angled instruments may pose insertion problems dueto interference with tissue or other anatomy.

In addition to the embodiments above, additional plate and spacersystems can be provided that are of low profile. These plate and spacersystems are advantageously capable of providing multiple options to asurgeon. In particular, they allow a surgeon to choose the type ofspacer (e.g., PEEK or allograft) to accompany the plate. In addition,they allow a surgeon to choose whether to use a straight bone anchor, acurved bone anchor, or a combination of both in order to be insertedinto a patient.

FIG. 73 is a top perspective view of a plate and spacer system withcurved bone anchors in accordance with some embodiments. The plate andspacer system 2500 is advantageously low profile. In addition, the plateand spacer system 2500 provides numerous options, such as the ability touse a PEEK or allograft spacer, as well as the ability to use straightor curved bone anchors.

The plate and spacer system 2500 comprises a novel, low profile plate2514 including a pair of bore holes 2526 for receiving a bone fastenertherein. In the present embodiment, the plate 2514 receives a pair ofnon-threaded, curved bone fasteners, shims or anchors 2300 (similar tothe curved bone fasteners in FIGS. 61 and 67). Advantageously, thesecurved bone fasteners 2300 can be easily impacted into bone, withouthaving to thread them therein. In other embodiments, the plate 2514 canreceived straight, threaded bone fasteners. In addition, in otherembodiments, the plate 2514 can receive at least one non-threaded,curved bone fastener and at least one straight, threaded bone fastener.The plate 2514 is configured to receive at least one blocking member2516. The blocking member 2516 can be in the form of a fastener withcutouts. In a first configuration, the cutouts of the blocking member2516 each align with a perimeter of the adjacent bore hole 2526, therebyallowing a bone fastener to pass therethrough. In a secondconfiguration, the blocking member 2516 is rotated such that the cutoutsdo not align with the perimeter of an adjacent bore hole 2526, therebypreventing a fastener from inadvertent backout.

In addition, the plate 2514 comprises torsional stabilizers 2563, whichprovides the system 2500 with stability as it is engaged with bone. Inthe present embodiment, the plate and spacer system 2500 includes a pairof upper torsional stabilizers 2563 for gripping a superior vertebraeand a pair of lower torsional stabilizers 2563 for gripping lowervertebrae. In some embodiments, the torsional stabilizers 2563 includepointed, knife-like edges, while in other embodiments, the torsionalstabilizers 2563 include blunted edges. In some embodiments, the plateand spacer system 2500 includes less than two or more than two uppertorsional stabilizers 2563, and similarly, less than two or more thantwo lower torsional stabilizers 2563.

The plate 2516 further comprises a pair of extensions or arms 2570 thatextend from a front plate portion. Each of the arms 2570 includes awindow 2572 that is designed to receive a bump out portion of the spacer2512, thereby connecting the spacer 2512 to the plate 2516. In someembodiments, the window 2572 comprises a fully-enclosed perimeter thatextends around a bump out portion of the spacer 2512. In someembodiments, the distal end of each of the arms 2570 comprises alateral, inwardly facing protrusion 2568 that is received in arespective notch or groove of the spacer 2512. Accordingly, the plateand spacer system 2500 advantageously include multiple ways to securethe plate 2514 to the spacer 2512 thereby forming a secure system.

As shown in FIG. 73, the plate 2516 includes a pair of channels 2550,2552 for receiving an insertion instrument therein. In some embodiments,the channels 2550, 2552 can differ from one another. For example,channel 2550 can comprise a full enclosed, threaded opening or hole thatis designed to receive a threaded portion of an instrument. Channel 2552can be a partially enclosed, non-threaded opening that includes a hookengagement cut out for receiving a non-threaded portion of aninstrument. In some embodiments, a single instrument (such as that inFIG. 42) can be provided that includes both a threaded portion and anon-threaded hook portion. The instrument can be used to deposit one ormore curved or straight fasteners.

The plate and spacer system 2500 further includes at least one spacer2512 that is attachable to the plate 2514. Advantageously, a surgeon canchoose the type of spacer 2512 to be attached to the plate 2514, such asan allograft spacer or PEEK spacer. The spacer 2512 includes a centralopening for receiving graft material 2520 therein. In addition, thespacer 2512 can include superior and inferior surfaces having surfacetexturing thereon to better engage adjacent vertebrae. In the presentembodiment, the spacer 2512 comprises a plurality of ridges on thesuperior and inferior surfaces.

FIG. 74 is a top perspective view of a plate and spacer system withstraight bone anchors in accordance with some embodiments. While theplate and spacer system 2500 is similar to that of FIG. 73 such that theplate 2514 and the spacer 2512 include similar features, the presentembodiment is shown as receiving straight, threaded bone fasteners 2516received through the plate 2514. The present embodiment thusdemonstrates the ability of the plate to receive either straight,threaded bone fasteners 2516 or curved, non-threaded bone fasteners oranchors 2300 depending on the desires of the surgeon.

FIG. 75 is a top perspective view of a plate in accordance with someembodiments. From this view, one can see the plate 2514 detached fromthe spacer 2512 without any fastener received therein. As shown in FIG.75, the bore holes 2526 of the plate 2514 can be non-threaded, and arecapable of accommodating any of the fasteners or anchors describedabove. In other embodiments, the bore holes 2526 can be completely orpartially threaded.

FIG. 76 is a front view of the plate of FIG. 75. From this view, one cansee the channels 2550, 2552 for receiving different portions of aninstrument therein. One can see how the channel 2550 comprises athreaded hole completed enclosed by a perimeter, whereas channel 2552comprises a non-threaded hole partially enclosed by a perimeter.

FIG. 77 is a top view of the plate of FIG. 75. From this view, one cansee a pair of lateral tracks 2580 that extend through sidewalls of theplate. These lateral tracks 2580 advantageously accommodate a pressassembly (not shown) that can be used to press a desired spacer 2512onto the plate 2514.

FIG. 78 is a top perspective view of a PEEK spacer in accordance withsome embodiments. The spacer 2512 comprises a C-shape spacer having asuperior surface and an inferior surface with a plurality of protrusionsformed thereon. In addition, the spacer 2512 comprises a flatly cutupper chamfer 2518 a and a flatly cut lower chamfer 2518 b for providingclearance to a screw or anchor that is inserted through the plate.

FIG. 79 is a top perspective view of an allograft spacer in accordancewith some embodiments. The spacer 2512 comprises a C-shaped spacerhaving a superior surface and an inferior surface with a plurality ofridges formed thereon. In addition, the spacer 2512 comprises a flatlycut upper chamfer 2518 a and a flatly cut lower chamfer 2518 b forproviding clearance to a screw or anchor that is inserted through theplate.

FIG. 80 is a top perspective view of an alternative allograft spacer inaccordance with some embodiments. The spacer 2512 comprises a C-shapedspacer having a superior surface and an inferior surface with aplurality of ridges formed thereon. In addition, the spacer 2512comprises a curved cut upper chamfer 2518 a and a curved cut lowerchamfer 2518 b for providing clearance to a screw or anchor that isinserted through the plate. In some embodiments, the curved chamfersbetter conform to a screw or anchor that is received through the plate.In addition, the curved chamfers 2518 a, 2518 b allow for more materialto be left on the spacer 2512 during manufacturing, which makes thespacer 2512 stronger.

One skilled in the art will appreciate that any of the plate systemsdescribed above can be used with other spinal implants. Among the otherimplants that can accompany the plate systems include stabilizationsystems and rod systems, including rod members, hook members, and bonefasteners such as pedicle screws. One skilled in the art will appreciatethat any of the plate systems described above can also be used with oneanother, or can be used multiple times along different segments of thespine. In addition, any of the plate systems described above can be usedwith a variety of navigation and guidance tools, including those relatedto neuromonitoring and robotics. Furthermore, one of skill in the artwill appreciate that the plate systems described above can be producedin a number of different ways, including in part via 3-D printingmethods.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the present inventionwithout departing from the scope or spirit of the invention. Moreover,the improved plate systems and bone screw assemblies and related methodsof use need not feature all of the objects, advantages, features andaspects discussed above. Thus, for example, those skilled in the artwill recognize that the invention can be embodied or carried out in amanner that achieves or optimizes one advantage or a group of advantagesas taught herein without necessarily achieving other objects oradvantages as may be taught or suggested herein. In addition, while anumber of variations of the invention have been shown and described indetail, other modifications and methods of use, which are within thescope of this invention, will be readily apparent to those of skill inthe art based upon this disclosure. It is contemplated that variouscombinations or subcombinations of these specific features and aspectsof embodiments may be made and still fall within the scope of theinvention. Accordingly, it should be understood that various featuresand aspects of the disclosed embodiments can be combined with orsubstituted for one another in order to form varying modes of thediscussed bone screw assemblies. Thus, it is intended that the presentinvention cover the modifications and variations of this inventionprovided that they come within the scope of the appended claims or theirequivalents.

What is claimed is:
 1. A spinal system comprising: a plate membercomprising a first opening for receiving a first fastener therein and asecond opening for receiving a second fastener therein, wherein thefirst fastener is configured to engage a bone member in an upwarddirection and the second fastener is configured to engage a bone memberis a downward direction, wherein the plate member comprises a first armextending from a first side of the plate member and a second armextending from a second side of the plate member; a first fastenerreceived in the first opening; a second fastener received in the secondopening; and a spacer member attachable to the plate member, wherein thespacer member engages the first arm and the second arm.
 2. The spinalsystem of claim 1, wherein the plate member comprises torsionalstabilizers.
 3. The spinal system of claim 1, wherein each of the firstarm and second arm includes a laterally extending protrusion.
 4. Thespinal system of claim 3, wherein the spacer member comprises a pair ofnotches, wherein each of the laterally extending protrusions of theplate member is configured to extend into a respective notch of thespacer member.
 5. The spinal system of claim 1, wherein the each of thefirst arm and the second arm includes a window formed therein.
 6. Thespinal system of claim 5, wherein the spacer member comprises a pair ofbump out members, wherein each of the bump out members are configured tobe received within a respective window.
 7. The spinal system of claim 5,wherein each window comprises a fully enclosed perimeter.
 8. The spinalsystem of claim 1, wherein the plate member comprises a first channeland a second channel for receiving a portion of one or more instrumentstherein.
 9. The spinal system of claim 1, wherein the first opening isthreaded and the second channel is non-threaded.
 10. The spinal systemof claim 1, wherein the spacer member comprises allograft.
 11. A spinalsystem comprising: a plate member comprising a first opening forreceiving a first fastener therein and a second opening for receiving asecond fastener therein, wherein the first fastener is configured toengage a bone member in an upward direction and the second fastener isconfigured to engage a bone member is a downward direction, wherein theplate member comprises a first arm extending from a first side of theplate member and a second arm extending from a second side of the platemember; a first fastener received in the first opening; a secondfastener received in the second opening; and a spacer member attachableto the plate member, wherein the spacer member engages the first arm andthe second arm and wherein the spacer member is formed of allograft. 12.The spinal system of claim 11, wherein the plate member comprisestorsional stabilizers.
 13. The spinal system of claim 11, wherein eachof the first arm and the second arm includes a laterally extendingprotrusion.
 14. The spinal system of claim 13, wherein the spacer membercomprises a pair of notches, wherein each of the laterally extendingprotrusions of the plate member is configured to extend into arespective notch of the spacer member.
 15. The spinal system of claim11, wherein each of the first arm and the second arm includes a windowformed therein.
 16. The spinal system of claim 15, wherein the spacermember comprises a pair of bump out members, wherein each of the bumpout members are configured to be received within a respective window.17. The spinal system of claim 15, wherein each window comprises a fullyenclosed perimeter.
 18. The spinal system of claim 11, wherein the platemember comprises a first channel and a second channel for receiving aportion of one or more instruments therein.
 19. The spinal system ofclaim 11, wherein the first opening is threaded and the second openingis non-threaded.
 20. The spinal system of claim 19, wherein the firstopening is completely enclosed and the second opening is partiallyenclosed.